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Optometrist sentenced to 33 months in federal prison for Medicare fraud

Thursday, Jan. 9, 2014 10:02 PM
Last updated 10:18 PM
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An Augusta-based optometrist who expanded a single office into a string of offices on both sides of the Savannah River will serve 33 months in prison for Med­icare fraud.

At the end of an all-day sentencing hearing in U.S. District Court on Thursday, Judge J. Randal Hall told Dr. Jeffrey Sponseller that what troubled him most about the hours of testimony was the defense’s apparent theme that bad employees and sloppy record-keeping were to blame.

“When it comes to health care fraud, a lot of people look at these types of cases and say, ‘Well, it’s just the government,’ ” Hall said. But it’s a crime against all taxpayers who must pay for care of the elderly and disabled covered by Medicare, Hall said.

Sponseller, 48, pleaded guilty in February to filing false claims. On Thursday, he admitted he defrauded Medicare and other government health care programs from January 2008 through 2010.

The investigation centered on Sponseller’s billing for Eye Care One services for nursing home patients in Georgia.

Because of the amount of fraud – which was the subject of Thursday’s hearing – Sponseller faced a sentencing range of 33 to 37 months in prison.

Defense attorney Pete Theo­­docion challenged the government’s calculations that Sponseller defrauded Med­i­care of more than $441,000.

The Medicare billing code Sponseller used most often was for the most comprehensive exam possible that would be needed for a new and medically complex case, according to testimony from Jean Stone, the director of the Northeast Integrity Field Operations of the Centers for Medicare and Medicaid Services.

When Stone studied case files collected from Spon­sel­ler’s office and nursing homes, the documentation was completely inadequate for such billing. In fact, it was so minimal that it wouldn’t qualify for any kind of Medi­care payment, she said.

Kim Reinken, an investigator with the U.S. attorney’s office, analyzed Sponseller’s billings and case files, finding that on a single day in July 2009, he billed Medicare for the 45-minute comprehensive exam on 177 patients.

She also found that Sponseller was the highest recipient of Medicare payments for that billing procedure in the nation. The second-highest recipient billed for less than half of what Sponseller did.

FBI Special Agent Paul Ku­bala testified that at one nursing home, Sponseller billed for comprehensive exams of 59 patients in about three hours. Four of those patients told the nursing home director that they never saw Sponseller, and another patient didn’t have eyes.

An investigator with the Of­fice of Inspector General of Health and Human Services, David Graupner, testified that in 2007, Sponseller was audited and placed in specialized tutoring for Medi­care billing because of questionable billing practices.

In 2009 and 2010, one of the billing codes Sponseller used was for a specialized photograph. No such photographs were found in any of his patient records, Graupner testified.

Assistant U.S. Attorney David Stewart argued that the nearly half-million dollars in restitution was a reasonable request. The government wasn’t seeking repayment of more than $1 million paid to Sponseller over the two-year period in question.

In the end, the judge sided with the prosecution. A telling factor for Hall was that while Sponseller was billing for a procedure required for a difficult diagnosis or a very ill patient, rarely did he seek payment for follow-up treatment of these patients.

THE BACK STORY

MEDICARE FRAUD

BACKGROUND: Jeffrey Sponseller of Eye Care One pleaded guilty Feb. 20 to making false claims for Medicare payments.

DEVELOPMENTS: Federal prosecutors estimated the loss of nearly a half-million dollars. The defense argued Thursday that the government failed to prove any loss.

• On Wednesday, the U.S. attorney’s office filed suit against Sponseller and the corporate owner of his former business, Eye Care One. The suit mirrors the criminal case and seeks to triple damages.

• On Thursday, Sponseller was sentenced to 33 months in federal prison. Restitution was set at $441,730. He must make $500 monthly payments while on three years of supervised release.

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IBeDogGone
3014
Points
IBeDogGone 01/09/14 - 11:21 pm
6
0
DO YOUR MATH

How is he going to pay back $441,730 making $500/month payments for 3 years. I caculate that to be only $18,000. After he is released from supervised release does he continue to make payments or he is off the hook?

CobaltGeorge
158360
Points
CobaltGeorge 01/10/14 - 02:41 am
5
2
At

$500.00 per month, it would take him 73.621666666 years to pay it off. I sure hope he is young and lives to be old.

corgimom
32231
Points
corgimom 01/10/14 - 06:56 am
8
0
He is going to be paying back

He is going to be paying back the money until he dies.

And that's what gets all these crooks, is greed.

He also will have all of his assets seized- and with that kind of money that he was stealing, he has significant assets.

harley_52
23272
Points
harley_52 01/10/14 - 11:11 am
3
0
Lots Of People...

...getting filthy rich by doing this sort of thing.

If the government was really serious about stopping fraud this is the area where they should concentrate first.

sand gnat
510
Points
sand gnat 01/10/14 - 11:50 am
3
0
Bottom Feeder

Bottom Feeders like this need to be put away for a long time for preying on the elderly at the expense of the public.

Sweet son
10372
Points
Sweet son 01/10/14 - 12:25 pm
1
1
Sounds like the Medicare auditors didn't do their job.

Somehow this type of abuse should have been caught by a good employee or a computer filter that picked up skewed figures.

I guess Medicare might use the same company for computers and programs as Obama did for his "Signature" mess!

GodisSoGood
892
Points
GodisSoGood 01/10/14 - 03:17 pm
2
0
Sweet son....the government

Sweet son....the government HIGHLY regulates the computer software that is involved with processing Medicare payments. I know because I worked with a Medicare contractor for almost 20 years, from claims processing to technical support. There are NUMEROUS mechanisms built into the system to catch potential fraud cases.

These providers should know there are mechanisms in the system to identify stacked billing (i.e., billing hundreds of patients for the same procedure on the same day) and fraudulent activity. The truth always comes out when it comes to committing fraud with Medicare. Testing, quality reviews, documentation of all procedures and processes is a vital part of the Medicare insurance business. Criminals such as these eventually get caught.

raul
4846
Points
raul 01/10/14 - 03:57 pm
2
0
Stupid and Greedy. Bad

Stupid and Greedy. Bad combination. This guy should have gotten 10 years minimum.

TrulyWorried
14113
Points
TrulyWorried 01/10/14 - 11:46 pm
1
0
Medicare fraud

If a Medicare patient attempts to report a single medicare fraud the office is not interested. Should one not suspect that there were others? Could have possibly opened up a can of worms.

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