Former Waldo Chiropractor Sentenced in $3 Million Medicare Fraud
KANSAS CITY, MO—Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that the former owner of a Kansas City, Mo., clinic was sentenced in federal court today for a $3 million Medicare fraud scheme.
Michael Kelly Miller, 59, of Temple Terrace, Fla., formerly the owner of Waldo Rehabilitation Health & Wellness in Kansas City, Mo., was sentenced by U.S. Chief District Judge Greg Kays to 15 months in federal prison without parole. The court also ordered Miller to pay $879,582 in restitution to Medicare.
On April 29, 2014, Miller pleaded guilty to health care fraud for submitting Medicare claims for nerve block injections that were not medically necessary.
Miller was a licensed chiropractor and the owner of Brookside Health Services, doing business as Waldo Rehabilitation Health & Wellness at 7337 Broadway, Kansas City, during the time period of February 2009 to December 2011. He later practiced at Miller Clinic for Optimal Health in Temple Terrace. Under the terms of his plea agreement, Miller has surrendered his chiropractic license.
Miller admitted that he submitted claims to Medicare for nerve block injections that were false and fraudulent because the nerve block injections were not medically indicated and necessary for the patients’ health per Medicare coverage guidelines. Between February 2009 and December 2011, the clinic billed Medicare approximately $3,083,454, and Medicare paid the clinic approximately $879,582 for nerve block injections.
Beginning in 2009, the clinic shifted its focus from primarily providing chiropractic services to purportedly diagnosing and treating neuropathy. This shift in focus was due, in part, to information Miller received from a third party promoting a new, “cutting edge” treatment for neuropathy, which included nerve block injections. At the time, Medicare had no specific coverage guidelines regarding the use of nerve block injections for peripheral neuropathy. Miller did not investigate or inquire whether Medicare considered nerve block injections to be medically indicated and necessary for patients experiencing neuropathy.
Miller’s patients typically received nerve block injections, anodyne infrared light and electrical stimulation therapies two or three times per week for four to eight weeks. The clinic’s purported treatment of neuropathy was not supported by medical research studies or peer-reviewed medical publications, and would be considered an experimental or investigational treatment or alternative medicine.
During this time, most of the clinic’s patients were Medicare beneficiaries, and most of the clinic’s revenues were received from Medicare. Medicare will not cover experimental or investigational procedures and treatments or alternative medicine. Miller was aware of these Medicare requirements.
This case was prosecuted by Assistant U.S. Attorneys Cindi S. Woolery and Daniel M. Nelson. It was investigated by the Department of Health and Human Services, Office of Inspector General and the FBI.