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Doctor pleads guilty to comp fraud in upcoding scheme


An Ohio physician pleaded guilty in federal court to defrauding the Ohio Bureau of Workers’ Compensation out of more than $260,000 by upcoding office visits to maximize reimbursements, the U.S. Department of Justice said in a statement Monday.

Dr. Kevin B. Lake, a doctor of osteopathic medicine, owned and operated a family medical practice in Columbus, Ohio. The practice morphed into a de facto pain management clinic starting in 2004 that gained a following of patients repeatedly seeking pain medication to feed addictions, according to charges brought against Dr. Lake in the U.S. District Court for the Southern District of Ohio, Eastern Division, in November. The practice prescribed more than 1 million doses of Schedule II and III controlled substances each year, an unusual pattern for a professional practice, the charges said.

Charges against Dr. Lake included that he willfully executed a health care fraud scheme to defraud the workers comp bureau by billing for services that were provided by a physician’s assistant but billed as if they had been provided by a physician to maximize reimbursement, according the charges. Other charges included that Dr. Lake maintained a drug-involved premises, committed tax evasion, conspired to commit mail and wire fraud, and stole government property.

Dr. Lake agreed to forfeit what remains of $29 million in proceeds the government seized from his operation after restitution is paid. The government and parties involved in the case recommended a sentence of five years in prison for Dr. Lake. District Judge Michael Watson has ordered a pre-sentence investigation.

“We place trust in our healthcare professionals to provide quality treatment that improves the health of injured workers,” said Sarah Morrison, administrator and CEO of the Ohio Bureau of Workers’ Compensation, which cooperated with the DOJ in its investigation of Dr. Lake. “We’re pleased to do our part to address the problem of prescription drug abuse in Ohio, as well as put an end to Dr. Lake’s fraudulent billing scheme.”

Three co-defendants have also pleaded guilty in the case, the DOJ said.



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