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Augusta optometrist pleads guilty to Medicare fraud

Wednesday, Feb. 20, 2013 12:28 PM
Last updated 10:25 PM
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An Augusta optometrist pleaded guilty Wednesday to defrauding Medicare.

According to court doc­uments filed in U.S. District Court, Jeffrey Spon­seller billed Medicare more than $800,000 between January 2008 and February 2011, much of it based on lies.

Sponseller, 47, the owner of Eye Care One at 3152 Wash­ington Road, came to the attention of federal agents when they received complaints about his billing practices, FBI special agent Paul Kubala testified Wednesday.

Agents reviewed hundreds of records from Spon­seller’s business obtained after a search in early 2011. Employees, former employees and witnesses at nursing homes throughout Georgia were interviewed during the investigation, Kubala testified.

They found that Spon­seller was the highest recipient in the United States of Medicare payments for one specialized billing procedure.

His total billing for that procedure was 143 percent higher than the next top biller, Kubala said.

Sponseller had a speciality practice for nursing home patients.

Standard medical procedures are coded for billing practices in the United States. The code that Spon­seller billed under repeatedly was for a comprehensive evaluation and treatment examination of a nursing home resident.

The procedure must take at least 45 minutes to perform, Kubala said.

On a single day – July 27, 2009 – Sponseller claimed in bills submitted to Medicare that he had seen 177 residents for that extensive evaluation at a nursing home in Americus, Ga.

If the minimum 45 minutes was spent with each patient, it would take nearly 133 hours to complete.

U.S. District Court Judge J. Randal Hall accepted Spon­seller’s guilty plea. He allowed Sponseller to remain free on a $25,000 signature bond with the standard restrictions for defendants awaiting sentencing in federal court.

Sponseller was granted permission to travel to Florida for a planned vacation.

Sponseller, who lives in a Martinez home valued at more than $566,000, has been a licensed optometrist in Georgia since May 2004.

His license, according to the secretary of state’s professional license online search, is still in good standing.

A sentencing date has not been set. Medicare fraud is punishable by a maximum five-year prison sentence.

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Austin Rhodes
2854
Points
Austin Rhodes 02/20/13 - 01:53 pm
15
1
If this isn't organized crime...

...I do not know what is.

He should be sentenced under the RICO act, and put into indentured servitude as the prison eye doctor for the next 20 years minimum!

THAT is how you discourage fraud!

Jake
32346
Points
Jake 02/20/13 - 03:44 pm
11
0
Vacation

How nice of the Judge to let him go on his planned vacation to Florida when he should be on permanent vacation in jail.
I would venture to say this "up-standing" citizen has lined his pockets with more dough than the 13 felony dude featured in todays editorial.

john
955
Points
john 02/20/13 - 04:15 pm
7
0
wow

I thought it was a rip off when I got glasses there. I had no idea

soapy_725
43676
Points
soapy_725 02/20/13 - 04:42 pm
1
0
Organized Crime's number one source of revenue.
Unpublished

More than any vice they have every perpetrated. The Medicare Hotline is a joke. Personal involvement for senor relatives. Billing goes on long after patients in nursing homes are deceased. So much for the funeral notification to SS.

Another great scam is the "speech therapy" treatments. These are requested for patients that actually "will not or cannot eat".

And the FL trip? FL is the number one state for Medicare Fraud. Time to check in with his fellow felons at large.

Fiat_Lux
15138
Points
Fiat_Lux 02/20/13 - 04:44 pm
5
2
Ugh

Ya gotta wonder how someone smart enough to do this honestly believes the government isn't going to catch on at some point. What a great thing to bring into your family's narrative.

I just hope Ol' Jeffery's wife doesn't end up getting sucked into this mess. I still have an appointment scheduled with her at MCG.

KSL
126874
Points
KSL 02/20/13 - 05:46 pm
5
2
Prison should be longer than

Prison should be longer than 5 years.

dichotomy
32151
Points
dichotomy 02/20/13 - 06:00 pm
8
2
Medicare (and Medicaid) is

Medicare (and Medicaid) is like an open checkbook to a lot...I said A LOT.....of doctors. Particularly those nursing home house call guys. It's just too tempting. Put a name and a code on a piece of paper and Medicare sends you a check. The doctors know that the governmnet rarely checks up on any of it......unless they just do something crazy like this guy did. And he has been getting away with it for years.

Of course that is what you get with government run healthcare. Their bragg that they can do it better because they have less administrative cost is because they don't bother to check whether the claims are valid or not. After all, it's just taxpayer money so why bother. Just cut a check and send it out. 177 claims from one doc in one day....no problem....cut him a check. I'll bet Blue Cross would have caught that one on the spot. But with Medicare it happens every day.

concernmom
403
Points
concernmom 02/20/13 - 06:33 pm
7
1
outrageous!

He basically stole money from the federal government and now gets to spend it on a nice vacation in Florida...unbelievable...

palmetto1008
9782
Points
palmetto1008 02/20/13 - 07:48 pm
1
9
Geesh!! This guy made a
Unpublished

Geesh!! This guy made a mistake or wasn't thinking correctly due to some emotional problems or the like. It would be wrong to treat him like some inner-city thug selling dope...those types are simply evil to the core. If he's going to prison, which is less than likely, he deserves some family time in Florida.

KSL
126874
Points
KSL 02/20/13 - 07:59 pm
6
2
He ought to pay back every

He ought to pay back every cent!

Gage Creed
16786
Points
Gage Creed 02/20/13 - 08:48 pm
3
0
Reading the posts of some "so

Reading the posts of some "so called" professionals could be construed as cruel and unusual punsihment. Norway is so much more progressive! (end sarcasm font)

Darby
25098
Points
Darby 02/20/13 - 10:07 pm
6
1
I've pretty much come to the conclusion.....

that some doctors are short-changed by the Medicare system. Still, if a doctor agrees to participate, then he should be willing to accept the reimbursement as determined by law.

Willow Bailey
20580
Points
Willow Bailey 02/20/13 - 11:09 pm
3
1
Did he do his own coding and

Did he do his own coding and billing? You just wouldn't think anyone would be this stupid. In an 8 hour day, he would have spent less than three minutes with each of them. What's even more amazing is it doesn't sound like anyone from Medicare caught it.

carcraft
25290
Points
carcraft 02/21/13 - 05:06 am
4
2
Don't worry folks, there will

Don't worry folks, there will be hundreds of Obama care Doctors to steal from you in the near future.

nocnoc
41415
Points
nocnoc 02/21/13 - 08:03 am
5
2
Actually a good Doctor

He saw me within 10 mins. of my appointment,
He spent time collecting my eye injury history,
Then he actually spent personal time explaining my options.

From a Doctoring stand point I will hate to lose him.
From a Taxpayer stand point, if true, we need to see him go.

soapy_725
43676
Points
soapy_725 02/21/13 - 08:31 am
0
0
Who pleads guilty anymore?
Unpublished

The Dr. must not have looked at the confused court system lately. Or he will be treated as a first offender and wash cars at the RCSO shop.

sugarbutton
818
Points
sugarbutton 02/21/13 - 09:56 am
1
1
Let me just say

Let me just say, my mother was ripped off so many times in her tenure as an assistant living dweller and in nursing homes. In the end something had happened to her medicare and after she passed away I started getting bills. As far as I'm concerned, they still owe her estate for doing things that didn't need doing or the lack of doing w hat they should have done. I say we're even. He estate has pennies left to pay any taxes left which her children will incur. IMO....we are even. I'm even getting a pharmacy bill from an assisted living home for 32 dollars from 5 plus hears ago when she was in hospital during 11 days of the beginning of the month. Home did NOT turn medicine in and she never took one dose of anything. She went from hospital to nursing home. They've spent more postage and time trying to collect it. Bill the assisted living home or whomever. She's dead so she's surely not going to need it now.

Fiat_Lux
15138
Points
Fiat_Lux 02/21/13 - 10:53 am
1
1
Dichotomy (as always) and Darby got it right

For nearly 80 years, our government has generally been run by people who care mostly about enriching themselves and their friends, and about their legacies, even if they started out with high ideals and dreams of serving selflessly. For the most part, they feign interest in the nameless, faceless rabble that are their fellow Americans, especially the downtrodden. But even the idealists ultimately are susceptible to the same temptations that have felled this optometrist. It's not true of all politicians, but those who can stay true are a small minority.

If the Feds would just take care of the military, the roads/airways/railways/interstate commerce and public health, the states could handle the rest-- probably far better and to a much higher standard even in relatively less well-off states.

tombee
35
Points
tombee 02/21/13 - 07:18 pm
0
0
Theft

This is theft pure and simple. I wonder what the guy would get who stole $800,000 worth of equipment from the military would get. Would they let him on a $25000 signature bond? Would he serve only 5 years? Get real. Treat all classes of people the same. This is actually worse than a one-time theft -- it involves multiple thefts. 5 years for every theft. Maybe that would get him what he deserves.

Darby
25098
Points
Darby 02/21/13 - 11:38 pm
2
0
That optometrist must have been pretty myopic...

not to have seen that coming.

Fiat_Lux
15138
Points
Fiat_Lux 02/22/13 - 05:10 pm
1
0
Cute

and clever, Darby.

Darby
25098
Points
Darby 02/22/13 - 06:12 pm
1
0
digiscrapdiva
2
Points
digiscrapdiva 01/03/14 - 11:28 am
0
0
I am in utter shock and

I am in utter shock and disbelief since reading this as well as a few other articles regarding the guilty plea made by Dr. Sponseller re: fraudulent claims to Medicare in the area of $880,000.
I've personally worked with both Dr. Jeff Sponseller and his optometric wife Tracie for quite sometime while they lived in Michigan. They were orig employed as Optometrists by First Optometry later by Henry Ford Health System- Optimeyes. A short while later they bought a franchise opportunity of their own in Wyandotte, Mi. I can not speak high enough in regards to Dr Jeff Sponseller, as he was never concerned with material goods, unlike the manipulative, ice princess who had quite a craving for the taste of the good life, nothing was ever good enough for her liking. He, on the other hand was always extremely mild mannered, very kind, compassionate, respectful & considerate in nature. (One of those too-nice kind of guys, that are pretty rare to run into)
Never once, while I worked with him, did he ever flaunt his title/authority as a Doctor, nor make his employees feel any less knowledgeable than him (if an employee didn't understand something- he'd teach them.)
He had a non-arrogant way about himself- (whereas most DO's & MD's I'd worked with over many, many years- in both Optometry & Ophthalmology made sure that we were to feel less educated than the "Dr's" we worked along side with!) I'm going to just stick with my gut feeling on this matter! I know that he personally would not take peoples money, not even the government/ tax payers money. He was simply not that kind of a person.
I remember all too well who made all the decisions, wore the pants in the family and included always having to have the final say in any matters whatsoever.
A personable man like Jeff Sponseller loves unconditionally -he just wants to provide protection. By him pleading guilty, it just reinforces my gut feeling that he is innocent with a capital "EYE"- He's only guilty of trying to protect someone he loves from being incarcerated because their own greediness. Sad.

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