Local Chiropractor and Billing Assistant Plead Guilty to Health Care Fraud Charges
ST. LOUIS, MO—Dr. Donald Havey and Susan Reno pled guilty to charges involving a scheme to bill Medicare for expensive ankle-foot orthotics that were never provided to the patients.
According to court documents, Havey owned and operated companies that sold orthotic devices through Spinal Decompression of Chesterfield; Senior Care, Inc.; Advanced Custom Orthotics, Inc.; and Missouri Custom Orthotics. Susan Reno and her company, Pinnacle Billings and Collections, provided billing services for Havey and each of his Companies.
Beginning in 2009 and continuing to 2014, Dr. Havey defrauded Medicare, Medicaid, other public and private health insurance companies, and patients by submitting false reimbursement claims for custom orthotic boots. The boots actually provided to the patients did not contain the custom features described in the reimbursement claims. Dr. Havey employed chiropractors to market his “Fall Prevention Program” to nursing homes and to sell the orthotic boots in Missouri and other states, including Texas, Alabama, California, Georgia, Illinois, Kentucky, Massachusetts, Mississippi, Oklahoma, Rhode Island, and Tennessee. Dr Havey and the chiropractors employed by him told the nursing homes that the Program would reduce falls by almost 20% and would improve the patients’ quality of life, but deliberately concealed from the nursing homes that the real purpose of the Program was to sell orthotic boots to nursing home patients. Dr. Havey also told the nursing homes that there would be little or no cost to the patients, when he knew that a Medicare patient could be charged as much as $500 if the patient did not have supplemental insurance.
Dr. Havey knew Medicare would scrutinize any company that submitted claims for a large number of very expensive orthotic boots, so he attempted to conceal from Medicare the number of orthotic boots that he and his Companies were selling. To accomplish this, Dr. Havey and Susan Reno submitted false claims under several of the Companies. As an example, a chiropractor assessed and ordered orthotics for five Medicare patients residing in the same facility on the same day. Dr. Havey and Susan Reno submitted two of the residents’ claims to Medicare using Advanced Custom Orthotics as the supplier and the other three were billed to Medicare using Senior Care Orthotics as the supplier.
Medicare paid Dr. Havey between $2400 and $2600 for each pair of orthotics boots. The loss to Medicare, Medicaid, and the private insurance companies was over $2.2 million.
Havey, 54, St. Louis County, MO, pled guilty to one felony count of health care fraud this morning before United States District Judge John A. Ross. Susan Reno, 40, St. Louis County, pled guilty to one misdemeanor count of submitting false reimbursement claims to Medicare before United States Magistrate Judge John Bodenhausen on October 16, 2015. Sentencing for Dr. Havey has been set for January 26, 2016. Susan Reno’s sentencing is set for January 11, 2016.
Felony healthcare fraud carries a maximum penalty of 10 years in prison and/or fines up to $250,000.
This case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, and the Missouri Medicaid Fraud Control Unit. Assistant United States Attorney Dorothy McMurtry is handling the case for the U.S. Attorney’s Office.