NEW YORK – The US Attorney's Office for the Eastern District of Missouri said last week that the former owner of a Missouri clinical laboratory has pleaded guilty to a felony conspiracy charge stemming from a testing fraud scheme.
According to the government, lab owner Carlos Himpler conspired with physician Franco Sicuro to fraudulently obtain, run, and bill urine toxicology tests, billing more than $3.8 million in fraudulent claims to Medicare, Medicaid, and private healthcare benefit programs.
Sicuro owned the healthcare business Advanced Geriatric Management (AGM). In 2014, Himpler and Sicuro opened an in-house testing lab at AGM as well as a separate clinical testing business, Genotec Dx, which operated out of the same building and used the same test analyzer and employee as AGM.
To obtain CLIA certification for Genotec, Himpler and Sicuro claimed falsely that Genotec's hours did not overlap with AGMs. Additionally, the two hid from insurers that Sicuro was a co-owner of Genotec while referring urine specimens from Sicuro's AGM practice to Genotec.
Himpler and Sicuro and other healthcare providers at AGM ordered urine toxicology tests for patients and referred those tests to AGM’s lab and Genotec, which in turn sent the samples to outside “reference” laboratories. According to Himpler, he and Sicuro knew that AGM and Genotec did not have the lab instrumentation necessary to confirm the toxins being tested for in the urine samples.
In 2015, the two men incorporated another lab company, Midwest Toxicology Group. The company never received CLIA certification or obtained lab equipment but was used for the purpose of billing insurers after those insurers became reluctant to pay tests billed by AGM and Genotec. In many instances, each lab submitted a claim for the testing of the same specimen obtained from the same person on the same day of service, a practice known as "split billing."
Himpler admitted in his plea agreement that Medicare, Medicaid, and private healthcare insurers paid $1.4 million in pass-through billing and $2.4 million in split billing. He faces up to five years in prison and a fine of up to $250,000. He is scheduled to be sentenced on May 15.
Sicuro pleaded guilty in November 2022 and was ordered to pay restitution. He also agreed to forfeit $3.1 million in assets.