Insurance Fraud NEWS
Pennsylvania doc charged with falsely billing for drug-relief meds
May 15, 2019, Delaware County, PA
A Delaware County doctor Wednesday was charged with filing fraudulent insurance claims to the tune of more than $390,000 dollars in a scam involving prescriptions to help those addicted to opioids, according to the Delaware County District Attorney's Office.
District Attorney Katayoun M. Copeland announced the arrest of Dr. Richard M. DiMonte Jr., who is charged with fraudulent insurance claims and theft by deception in the amount of $394,900. The case involves prescriptions for Vivitrol, a medication prescribed to treat opioid addiction.
DiMonte, 54, of the 300 block of West Third Street in Media, is a physician who practices family medicine and owns Front Street Family Medicine and Jasper Health Inc. based in the county seat. He is a provider of Vivitrol and Suboxone, which are medicated assisted treatments for opioid addicted patients, according to a press release from the D.A.'s office.
DiMonte is charged with 152 counts of false and fraudulent insurance claims, felonies of the third degree, and four counts of theft by deception, felonies of the second degree.
DiMonte was preliminarily arraigned before Magisterial District Judge Diane M. Holefelder, who set bail at $400,000 unsecured. He faces a preliminary hearing scheduled for June 3, 2019, before Magisterial District Judge Deborah Krull. Assistant District Attorney William J. Judge is prosecuting the case.
"In the midst of an opioid epidemic, Dr. Richard DiMonte fraudulently obtained $394,900 worth of medication, deceiving insurance companies under the guise of helping opioid dependent policy holders who sought help and treatment from him," Copeland said.
The arrest comes at the conclusion of a lengthy investigation by Sgt. Lawrence Patterson and analyst Edward Lowitz of the Delaware County District Attorney’s Office Criminal Investigation Division (CID), with assistance from Independence Blue Cross Investigators Michael Ebner, Benjamin Beddis, Justin Cottrell and AmeriHealth Caritas Insurance Investigator Keith Miller.
Copeland said the investigation revealed that Independence Blue Cross and AmeriHealth Caritas insurance companies were paying multiple pharmacies to provide Vivitrol to DiMonte. Many patients had numerous Vivitrol shots sent to DiMonte in their name and paid for by their insurance companies, but which they never received from the doctor. The D.A. alleges this in turn caused false insurance claims and inaccurate payments by the insurance companies for undelivered services to DiMonte’s patients along with a stockpile of Vivitrol, which Dr. DiMonte then administered to other patients, charging uninsured patients cash.
On July 28, 2015, CID Sergeant Lawrence Patterson met with Independence Blue Cross investigators regarding possible insurance fraud being committed by DiMonte. This investigation allegedly revealed order and billing discrepancies where more Vivitrol vials were being requested and shipped to DiMonte than were being administered to prescribed patients. This resulted in a $200,200.00 loss to Independence Blue Cross in fraudulent insurance claims where patients did not receive their Vivitrol prescription, which was billed to their insurance company and delivered to DiMonte.
Further investigation revealed that DiMonte also billed AmeriHealth Caritas Insurance for Vivitrol. CID Detective Edward Kazlo and Sgt. Patterson met with AmeriHealth Caritas investigators on Jan. 11, 2017, that revealed a similar discrepancy where DiMonte received more Vivitrol than what he administered to patients. This resulted in a $194,700 loss to AmeriHealth.
CID detectives interviewed more than 100 of DiMonte’s patients who had either Independence Blue Cross or AmeriHealth Caritas medical insurance. The interviewed patients described the number of Vivitrol shots they received, which were consistently less than the shots billed to the insurance company and the quantity mailed to DiMonte. Analysis of DiMonte’s patient records and investigation revealed that 152 patients were prescribed Vivitrol that was sent to DiMonte and billed to their insurance company even though these patients never received the medication.
Source: Daily Times