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| Dear Friend,
10 years in federal prison. Plus more.
What is your favorite dessert, something that goes well with barbecue?
Whether it is pie or vanilla ice cream (or both!), it is probably not 10 years in federal prison.
That is the just desert dished out to spine surgeon Mark Kuper, D.O. in late February 2021 for his role in a conspiracy to defraud Medicare, Medicaid, and Tricare.
Front and center in the story are Mark Kuper, D.O., and his wife (and errant barbecue
pit-master) Melissa Kuper.
The Salad Days
Dr. Kuper, trained as an orthopedic surgeon, initially practiced in that medical specialty, but,
apparently as a result of medical malpractice lawsuits, gave up his surgical practice. Instead,
in 2014, he began operating a pain management practice, the Texas Center for Orthopedic
and Spinal Disorders (“TCOSD”), from two clinic locations. Mrs. Kuper served as TCOSD’s
office manager.
In 2016, a TCOSD employee, Richard Brown, filed an original, sealed whistleblower complaint against Dr. Kuper, alleging a host of False Claims Act violations.
As a result, in spring and summer 2017, the U.S. Department of Health and Human Services and the Texas Attorney General’s Medicaid fraud unit issued subpoenas to Kuper and TCOSD seeking medical and billing records related to federally funded healthcare programs.
It is reported that, after receiving the subpoenas, Dr. Kuper paid his staff overtime to put the practice’s records into cardboard boxes which were then taken by Dr. and Mrs. Kuper to their approximately 7,800 sq. ft. home outside of Fort Worth.
Overcooked
On what was probably a breezy day in October 2017, Mrs. Kuper decided to barbecue some medical records in their home’s outdoor fireplace in a misguided (on multiple levels) attempt to destroy evidence. Apparently forgetting one of the basic rules of starting a fire, she left it unattended. Before long, their mansion was in flames. In no time at all, it burned to the ground.
But not all of the medical records did; firefighters found a recognizable pile of them in the fireplace.
At the end of May 2020, the U.S. Government intervened in the whistleblower suit brought by Mr. Brown. And, on June 17, 2020, both of the Kupers as well as a physical therapist associated with TCOSD practice, Travis Couey, were criminally indicted for conspiracy to commit health care fraud, for health care fraud itself, and for unlawful distribution of controlled substances.
Just Deserts
Three months after the indictment, Dr. Kuper pleaded guilty to one count of conspiracy to commit healthcare fraud. In late February 2021, he was sentenced to 10 years in federal prison.
In connection with his plea, Dr. Kuper admitted:
- That he fraudulently built insurance for services that were never rendered, including physical therapy and psychotherapy.
- That patients were required to attend bogus appointments in order to obtain prescriptions for Schedule II controlled substances.
- That he used a boilerplate template for physical therapy plans although he submitted claims stating that TCOSD developed individualized plans for each patient.
- That TCOSD billed for one-on-one therapy, even though patients met in groups with a trainer, not a physical therapist.
- That he gave his wife access to the secure device and passcode he used to sign controlled substance prescriptions, allowing her to improperly dispense pain medications on her own initiative, without his input.
- That although he billed insurers for professional 60-minute psychotherapy sessions, most patients actually spoke with unqualified professionals for just 15 to 20 minutes – often when he was out of the office.
According to the Department of Justice’s press release, Dr. Kuper billed as though he had provided more than 100 hours’ work in a single 24-hour day. From 2014 to 2017, he submitted more than $10 million in claims to Medicaid, Medicare, and TRICARE.
The DOJ also stated that Dr. Kuper tried to cover up evidence of the fraud by accessing hundreds of electronic patient records and altering the purported treatment notes to make them appear more comprehensive.
Melissa Kuper pleaded guilty in September 2020 and received an 18 month sentence. Travis Couey, the TCOSD physical therapist, pleaded guilty in September 2020 and received a 36 month sentence. |
| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Watch Tuesday's video here, or just keep reading below for a revised, more polished transcript:
This has to do with a really interesting whistleblower case that has some extremely important lessons for all sorts of providers.
It is a False Claims Act case rooted in violations of the federal anti-kickback statute and STARK. What is interesting is that in almost every whistleblower case I have read recently, the whistleblower has been somebody with inside information. Either a member of the group, a hospital employee, an administrator, or somebody from an outside billing service.
These people have access to copies of billing information and/or copies of inside documents. All of which taken together are enough to meet particular requirements of pleading in court, a whistleblower action, a False Claims Act action.
This case involves somebody who is a complete stranger. It involves a real estate appraiser, who basically conducted his own investigation in connection with a hospital project he saw being developed. He unearthed information, not about any particular claim, he does not have any information that Ms. Jones was charged for services billed for Medicare and there was an underlying kickback. Instead, he was able to show, at least to get past the motion to dismiss stage, which is going to set him up for settlement.
He was able to demonstrate a systemic kick-back. In other words, the relationship between, in this case, a medical office building developer and a hospital company provided benefits that were passed through, he argues, to physician tenants.
Even though he can not point to one (for example a Medicare or Medicaid claim) that systemic defect, the discounts involved in an underlying real estate transaction, were enough to pass the motion to dismiss.
So, this completely broadens the scope of who can bring a case. It completely broadens the scope of who can be a whistleblower.
Additionally, it shows that you do not need to have specific evidence of an underlying
anti-kickback or STARK violation. Just that description of a systemic error. Something about the way the system, the relationship between the hospital, the medical group and the referring physician or physicians is set up, can trigger False Claims Act liability.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | Wednesday - Ghost of Eliot Ness Busts 345 Defendants in Nation’s Largest Opioid-Fueled Healthcare Fraud Extravaganza - $6 Billion In Alleged False Claims - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
In a move reminiscent of prohibition-era crime fighter Eliot Ness, the U.S. Department of Justice recently announced a coordinated enforcement action against 345 alleged healthcare criminals, including over 100 physicians and other licensed (for now) healthcare professionals, in 51 judicial districts.
The defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers.
Of that sum, over $4.5 billion relates to telemedicine, more than $845 million is connected to substance abuse treatment facilities, or “sober homes,” and over $806 million relates to other health care fraud and illegal opioid distribution schemes.
Telemedicine Scheme:
Unfortunately, the structure of the telemedicine scheme is one that I have seen play out multiple times, sometimes with enough time to avert a client’s participation:
Step 1: Certain defendant telemedicine executives allegedly used marketing networks to lure unsuspecting “patients” into the scheme via telemarketing, direct mail, TV ads, and internet ads. Call centers confirm Medicare or Medicaid eligibility and transfer the individuals to the telemedicine company.
Step 2. The telemedicine companies, controlled by the defendants, then allegedly pay defendant doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications. Either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.
Step 3: The telemedicine defendants then allegedly sell (as in illegal kickbacks and bribes) the physician's or nurse practitioner's orders to defendant DME companies, genetic testing laboratories, and pharmacies. Which, pursuant to the Government’s allegations, subsequently submitted false and fraudulent claims to Medicare and other government insurers. |
| | | Listen to the podcast here, or just keep reading for the transcript.
When I was a kid, I had a Gumby. (Did you have one, too?)
In common with other businesses, medical groups often assume that deals and decisions are like on–off switches, yea or nay, thumbs up or thumbs down.
The truth is that although many view the world that way, decisions and paths are far more flexible, more fluid, more customizable. They are infinitely adjustable, like Gumby.
That is where the value is: in the nuances within the design of a deal or of a decision.
That is how you must think. Not black or white, not yes or no, not right or left, but green, rubbery and bendable — like Gumby.
For example, many physician groups believe that they are faced with the decision to remain independent or to sell. Yet that is a binary question: “on” or “off.”
The reality is that there is a plethora of other choices. For example, to name but a very few: merge with another practice, hire to expand, acquire another practice outright, capture the referral sources or contracts that presently benefit another group, and so on.
And then, within each one of those routes there are multiple alternatives and multiple ways to structure the deal or effort.
Need a reminder? Go buy a Gumby and put it on your desk at work or at home. Every once in a while, pick it up and play with it. (You still remember how, right?)
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| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this
time? How can we focus on solutions to your most pressing strategic concerns?
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back.
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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