A pair of pain physicians pleaded guilty to conspiring to defraud three major payers by submitting claims for corticosteroid injections that were never administered.
Twin brothers Desi Barroga, MD, and Deno Barroga, MD, both 51, pleaded guilty to one count each of conspiracy to commit healthcare fraud, according to a May 21 Justice Department news release. The pair admitted they conspired to defraud Blue Cross Blue Shield, Cigna, and United Healthcare.
The brothers admitted that they billed payers at least $45 million and received at least $9 million as part of the scheme, according to the release.
As part of the scheme, they required patients to submit to monthly office visits, according to the report. This allowed patients to continue receiving addictive Schedule II controlled substances, such as hydrocodone and oxycodone, while allowing the brothers to bill patients' insurance companies for expensive services they never provided.
The pair told payers that they performed as many as 80 corticosteroid injections per patient per visit, but a majority of these injections were never administered, according to the release. They also created fake medical records which were often cut and pasted, or cloned, from patient to patient with little to no variation. They instructed patients to include false statements pertaining to the injections and other treatments in the record.
Under the terms of the plea agreement, both physicians agreed to surrender their DEA registrations and forfeit their medical licenses at least 14 days prior to sentencing, according to the release. They also agreed to pay restitution in an amount to be determined at a later date. They each face up to 10 years in prison.