NEW YORK — The co-owner of several healthcare companies, including at least one clinical laboratory company, has been sentenced to 20 months in prison and ordered to pay $100,000 for submitting $3.8 million in fraudulent claims to Medicare and Medicaid, the US Attorney's Office for the Eastern District of Missouri said Tuesday.
According to the attorney general's office, Carlos Himpler and co-defendant Franco Sicuro owned Advanced Geriatric Management in Creve Coeur, Missouri, and opened an in-house testing lab at the company in the fall of 2014. They also opened Genotec DX, which the attorney general's office said was "held out as a clinical testing laboratory," was housed in the same building as AGM, and used the same testing device as AGM's lab.
Himpler and Sicuro sought CLIA accreditation for both labs without disclosing that the labs employed the same part-time employee who ran tests on the same testing platform. In order to get a final CLIA certificate of compliance, the defendants made certain misrepresentations about Genotec, including its testing hours, to appear as if they did not overlap with AGM's testing hours. Himpler and Sicuro also claimed that AGM had stopped running samples and transferred its employees in 2015 to Genotec, which did not begin running samples until July of that year.
In truth, AGM's lab continued operations past July 2015 and Genotec began testing samples several months before then, the attorney general's office said.
The defendants hid Sicuro's ownership of Genotec from Medicare, Medicaid, and private health insurers and referred urine samples from his own medical practice, AGM, to Genotec.
Meanwhile Himpler, Sicuro, and other providers ordered urine toxicology tests and referred them to AGM and Genotec, which sent the samples to outside reference labs, knowing AGM and Genotec did not have the right equipment to perform the toxicology tests, Himpler said in his plea, according to the attorney general's office. The two then billed insurers for the testing, knowing Medicare, Medicaid, and many private insurers do not allow billing for tests performed by other parties.
In March 2015, Himpler and Sicuro founded another laboratory firm, Midwest Toxicology Group, in response to pushback from health insurers to Genotec's reimbursement claims. The attorney general's office said Midwest was not, in fact, a lab and was not authorized to perform tests on human samples. In some cases, Midwest and Genotec separately submitted claims for testing performed on the same specimen obtained from the same person on the same day. Additionally, Midwest used Genotec's CLIA number on claims submitted under Midwest's name, the attorney general's office said.
In his plea, Himpler admitted that Medicare, Medicaid, and private health insurers paid $1.4 million in pass-through billing and $3.4 million in split billing to the labs owned by him and Sicuro.
Himpler pleaded guilty to the attorney general's charges in February, while Sicuro pleaded guilty in November 2022 and has satisfied the restitution owed. He has agreed to forfeit $3.1 million in assets.