Port Arthur Pain Management Clinic Manager Sentenced
|U.S. Attorney’s Office December 21, 2009|
BEAUMONT, TX—U.S. Attorney John M. Bales announced today that a 37-year-old Houston man has been sentenced to federal prison for a health care fraud scheme in the Eastern District of Texas.
ASHLEY COLIN WALKES pleaded guilty on June 3, 2009, to Misprision of Health Care Fraud and was sentenced to 36 months in federal prison today by U.S. District Judge Marcia Crone. Walkes was also ordered to pay restitution of $4,315,280.21 to Medicaid, $514,390.24 to Medicare and $70,585.55 to Blue Cross Blue Shield, for a total of $4,900,256.00 in restitution. Walkes was also ordered to forfeit three bank accounts valued at about $500,000.00.
According to information presented in court, Walkes was the manager of 4500 Gulfway Medical Management, also referred to as Medic Management, which operated primarily as a pain management clinic in Port Arthur and was effectively closed by the initiation of the investigation. Under Walkes' direction, the clinic saw up to 100 patients a day, most receiving Hydrocodone, Soma, and Xanax for pain management. Walkes, who had no medical training, ordered Medicaid, Medicare, and private insurance patients to attend physical therapy sessions in order to receive their prescription refills. However, cash patients were not required to attend those sessions. These sessions were then billed as if a physician had performed them, but, as Walkes was aware, they were actually performed by untrained, unlicensed, unsupervised personnel. Further, Medicaid, Medicare, and BCBS were billed for multiple physical therapy sessions each time the patient attended.
In a separate scheme, Walkes directed Medicaid and Medicare to be billed for thousands of physician office visits at a code indicating the patient spent 25 minutes with the physician, when the physician actually spent five minutes or less with each patient.
Walkes, who only worked three days a week, paid himself over $4 million in cash and personal expenditures.
This case was investigated by the Texas Attorney General's Office, Medicaid Fraud Control Unit and the Federal Bureau of Investigation and prosecuted by Assistant U.S. Attorney Christopher Tortorice and Assistant U.S. Attorney Bob Rawls.