ST. LOUIS – A Chesterfield, Missouri psychiatrist on Tuesday pleaded guilty before U.S. District Judge Sarah E. Pitlick to a felony conspiracy charge and admitted that Medicare, Medicaid and other insurers lost more than $3.8 million based on fraudulent reimbursement claims filed by clinical laboratories that he owned.
Dr. Franco Sicuro, 67, also agreed to forfeit $3.1 million from various sources.
Sicuro managed, owned, served as medical director of, or was associated with, healthcare businesses including Millennium Psychiatric Associates LLC (MPA), Advanced Geriatric Management (AGM), Centrec Care, Sleep Consultants of St. Louis LLC, Midwest Toxicology Group, Genotec Dx and Benemed Diagnostics LLC.
In 2014, AGM was certified under the Clinical Laboratory Improvement Amendments (CLIA) and subsequently licensed to perform quantitative laboratory testing. That same year, Sicuro and Carlos Himpler opened another lab, Genotec, which was in the same building as AGM but would bill insurance companies as a separate “out-of-network” lab. To obtain CLIA certification for Genotec, Himpler and AGM personnel falsely claimed that AGM and Genotec operated as separate laboratories, even though AGM and Genotec shared one part-time employee, the same medical director and the same testing equipment, the Sicuro’s plea agreement. Without CLIA certification, Genotec would not be able to perform any clinical laboratory tests.
Sicuro also admitted in his plea that he chose to remain “willfully ignorant” of the fact that his financial interest in Genotec was hidden from private health insurers, Medicare and Medicaid. As a result, the insurers were unaware that Sikuro and AGM employees were referring patients for urine tests to a laboratory in which Sikuro had a financial interest.
Sikuro also acknowledged that he and other health care providers at AGM, MPA, Sleep Consultants and Rest Easy of St. Louis LLC, a company run by Himpler, ordered clinical lab tests, including urine toxicology tests, which AGM and Genotec then sent out to “reference” labs for more advanced tests that would show the amounts of the drugs, rather than just detect their presence, as AGM’s laboratory equipment did.
AGM or Genotec paid reference labs about $125 per test and then billed insurers substantially more, but did not disclose to insurers that neither AGM nor Genotec actually performed the tests. Medicare, Medicaid and many private insurers would not have paid the “billing shift” claims if they had known about it, Sikuro’s filing said.
In 2015, Sicuro and Himpler incorporated Midwest, which they kept as a clinical testing lab, even though it didn’t have the equipment, staff or supplies needed to run tests. In addition, Midwest was not CLIA certified or authorized to perform testing on human samples. Sicuro admits that he and Himpler knew Midwest was a lab in name only, but had Midwest bill for clinical lab tests. Sicuro further admitted that he either knew or was willfully blind to the fact that Himpler had used Genotec’s CLIA certification number in reimbursement claims filed by Midwest, misleading health insurers into believing that Midwest had performed the tests. Genotec and Midwest also often “split accounts”; each submitted a claim for testing the same sample received from the same person on the same day of service.
Sikuro is scheduled to be sentenced on February 8. He faces up to five years in prison and will be ordered to repay the money.
“Providers engaging in fraudulent schemes not only compromise the integrity of essential federal health care programs, but also waste valuable taxpayer dollars,” said Special Agent in Charge Kurt L. Mueller of the Department of Health and Human Services, Office of Inspector General ( HHS-OIG). “Along with other law enforcement agencies, HHS-OIG is holding accountable bad actors who use these programs for personal gain.”
The case is pending against Himpler, 51, of Baton Rouge, Louisiana. He has pleaded not guilty to conspiracy, health care fraud and money laundering charges.
The case was investigated by the FBI, the US Department of Health and Human Services and the Office of Inspector General and the IRS. Assistant U.S. Attorneys Dorothy McMurtry, Amy Sestrick and Kyle Bateman are prosecuting the case.