As we pointed out in last week's blog, Medicare fraud takes on many forms. Because Medicare is such a massive government healthcare program, it creates opportunities for fraudulent individuals and organizations. Sadly, as our blog has long proven, many exploit the system for financial gain. Fraudulent activities allow perpetrators to fraudulently obtain reimbursement from Medicare, resulting in significant financial incentives.
Colby Edward Joyner is one such perpetrator. As announced by the Western District of North Carolina branch of the U.S. Attorney's Office, the 35 year-old physician assistant was found guilty of a $10 million Medicare fraud scheme. A federal jury in Charlotte returned a guilty verdict yesterday.
Joyner took part in a genetic testing scheme.
It resulted in the submission of more than $10 million in fraudulent claims to the Medicare program and more than $3.6 million in payments. Officially, the North Carolina-based physician assistant was convicted of one count of health care fraud and six counts of making false statements relating to health care matters.
Trial evidence, witness testimony and documents filed with the court confirmed that, in 2018 and 2019, Joyner was a physician assistant. He worked in the Charlotte area as an independent contractor for a physician staffing and telemedicine company. During those two years, Joyner signed fraudulent prescriptions for medically unnecessary genetic testing.
Joyner never met any of the beneficiaries he signed prescriptions for.
The bogus prescriptions were specifically for cancer genomic and pharmacogenetic testing. By signing them, Joyner took advantage of hundreds of Medicare beneficiaries residing in North Carolina. “Joyner had never met, seen or treated the beneficiaries, and only had brief telephone conversations with them or no interactions at all,” says the U.S. Attorney’s Office report.
Evidence at trial showed that the telemedicine company and its clients gave Joyner pre-populated prescription forms and related records. They were for patients who were pre-selected for genetic testing. Joyner then electronically signed and returned the forms purporting to have performed consultations. He received $12 and later $15 for each form.
Joyner falsified medical records in connection with the unnecessary prescriptions.
He also falsely certified that the genetic tests were medically necessary. Evidence at trial showed that these actions were all in the name of concealing that he was not the beneficiaries’ treating physician and that he did not conduct medical evaluations or examinations of the beneficiaries.
Joyner has been released on bond and is awaiting a sentencing date that has not yet been set. He faces up to 10 years in prison and a $250,000 fine for the health care fraud charge. As well, he faces up to five years in prison and a $250,000 fine for each count of making false statements relating to health care matters.
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