CEDAR RAPIDS – A Northern Iowa doctor will pay a price for falsely stating he was spending more time with patients in nursing homes than he was actually spending with them.
Dr. Joseph X. Latella, a primary care doctor in Webster City, Iowa, was recently sentenced to two months in prison and to pay a fine after previously pleading guilty to making false statements related to health care matters. Dr. Latella has also agreed to pay $316,438.96 to resolve False Claims Act allegations relating to claims he submitted for routine visits for nursing facility residents between January 1, 2014, and November 30, 2018. The United States alleged that Dr. Latella submitted claims to Medicare and Medicaid for the most intensive and expensive claim code for such visits when, in fact, he was not performing services sufficient to justify use of that code.
Dr. Latella admitted in a plea agreement that, in June 2018, the United States Attorney for the Northern District of Iowa was conducting a civil investigation about concerns that Dr. Latella was “upcoding” claims submitted to Medicare and Medicaid and billing for more intensive visits with patients at Webster City area nursing homes than he had performed. The United States Attorney’s investigation indicated that Dr. Latella was billing over 93% of his nursing home visits to Medicare under the most intensive and expensive claim code. For these claims to be valid, a doctor typically must spend 35 minutes at the patient’s bedside and on the patient’s facility floor or unit. Medicare paid more than $94 for these claims, but would only have paid no more than $32 if the least expensive claim code, for routine ten minute visits, had been billed. In July 2016, a Medicare contractor sent Dr. Latella a letter warning him that his billing patterns were significantly more expensive than other doctors.
In July 2018, Dr. Latella submitted sworn written answers to the United States Attorney, in which Dr. Latella falsely declared that, with respect to certain Medicare claims in 2017 and 2018, he had spent approximately 35 minutes for each of 12 patients’ care at two nursing homes. With respect to one particular date in October 2017, Dr. Latella falsely swore he “started visiting the nursing home patients at 7:30 a.m. and completed my visits with each patient at approximately 5:30 p.m.” In truth, a federal agent had conducted in-person surveillance of Dr. Latella on that date, and Dr. Latella only was on site at the first nursing home for a total of 47 minutes and did not visit the second nursing home at all on that date. The administrator of the first nursing home estimated that Dr. Latella spent approximately five minutes with each nursing home patient during his visits to that nursing home.
Dr. Latella made further false statements about claims in January and February 2018, which the Medicaid Fraud Control Unit discovered through videotaped surveillance. For example, Dr. Latella billed nine claims for services allegedly provided to nine Medicare patients, on February 2, 2018, at a nursing home, but the surveillance showed that Dr. Latella was only on site at the nursing home for a total of 14 minutes.
Dr. Latella provided the United States Attorney with fraudulent, re-created treatment notes in order to cover up his overbilling scheme. Dr. Latella’s staff had a practice of shredding all notes for all nursing home patients immediately after billing the taxpayers for those services; at the time of the audit, therefore, Dr. Latella had no records of any of the treatment he had ever provided to patients at the nursing homes. To re-create the notes, Dr. Latella contacted the nursing home administrators and nursing managers of various nursing homes and asked for copies of patients’ charts. In truth, elderly residents of nursing homes did not receive the care for which taxpayers paid him, and these vulnerable nursing home residents’ family members cannot know whether and to what extent those nursing home residents received medical care from Dr. Latella over the years.
Dr. Latella was the medical director of two nursing homes at which he was billing fraudulently. Dr. Latella also was the Hamilton County Coroner, provided services to inmates in the Hamilton County Jail and in the custody of the United States Marshal’s Service, and he also evaluated workers’ compensation claims for a major Webster City employer.
In total, Dr. Latella admitted that, between January 1, 2014, and November 30, 2018, he submitted 1,140 false claims to Medicare, which were not justified, and he was paid $107,980.59 by Medicare for those claims. Dr. Latella also admitted that he caused Medicaid to make unjustified payments in the total amount of $9,218.73 for these claims. As a part of his plea agreement, Dr. Latella has agreed to pay no less than $107,980.59 to Medicare and $9,218.73 to Medicaid for economic losses caused by his commission of the offense.
“Like all providers, doctors who treat Iowa’s elderly population have a duty to provide needed medical services and bill accurately for those services. By his alleged actions, Dr. Latella scammed the healthcare system and left his elderly patients and their families wondering if the patients received care they needed,” said Peter E. Deegan, Jr., United States Attorney for the Northern District of Iowa. “When our office’s civil investigators made an official inquiry into his billing practices, Dr. Latella tried to throw the government off the scent by lying and creating false records. This settlement and prosecution demonstrate my office’s focus on ensuring Medicare and Medicaid beneficiaries receive the care to which they are entitled, public monies are well spent, and individuals or entities responding to my office’s civil investigative demands provide complete and truthful responses.”
“Government health care rules require bills be submitted only for services actually provided – anything more is fraudulent and a disservice to patients needing vital care,” said Curt L. Muller, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “We will continue to protect the integrity of government health care programs and taxpayers funding these vital services by holding providers fully accountable.”
The civil matter arose from an affirmative investigation. False Claims Act cases can also be brought under the qui tam provisions of the Act, which encourage whistleblowers to bring suit on behalf of the United States and share in any financial recovery. The civil case was handled by Assistant United States Attorneys Melissa Carrington and Jacob Schunk. The criminal case was prosecuted by Assistant United States Attorney Tim Vavricek. The cases were investigated by the Department of Health and Human Services, Office of the Inspector General, and the Iowa Medicaid Fraud Control Unit.