Dallas Ad Exec Admits Role In $40M Health Care Fraud - Insurance News | InsuranceNewsNet

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January 11, 2017 Newswires
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Dallas Ad Exec Admits Role In $40M Health Care Fraud

Dallas Observer (TX)

Kelly Loter, 48, the owner of Dallas' Level Two advertising firm, has admitted his role in what he describes as a massive healthcare fraud scheme. The U.S. Department of Justice says Forest Park Medical Center paid more than $40 million in bribes and kickbacks in exchange for patient referrals.

Surgeons, primary care physicians, chiropractors, lawyers, worker's compensation pre-authorization specialists and others took cash to route patients to Dallas' Forest Park Medical Center, an out-of-network hospital. The owners of the hospital - Alan Beauchamp, 64; Richard Toussaint Jr., 58; Wade Barker, 51; and Wilton Burt, 61 - then set their own, higher prices for procedures, eventually receiving a substantially higher reimbursement rate from insurance companies than they would've otherwise.

In court documents filed this week, Loter admits that he helped Forest Park Medical Center's owners carry out their alleged fraud by serving as a middle man. Physicians, according to Loter, were offered advertising from Level Two in exchange for performing surgeries and other procedures at Forest Park Medical Center. The hospital owners would, in turn, pay Loter for the advertising.

"The agreement was always the same," the plea documents say. "FPMC would pay for all or some of the surgeons' personal marketing through Level Two in exchange for the surgeon bringing certain surgical cases to FPMC."

In two separate cases, Loter admitted to receiving between $25,000 and $50,000 a month to market a doctor who brought surgeries to Forest Park Medical Center.

Despite that fact that Forest Park Medical Center did not take Medicare patients, Loter's marketing did draw Medicare beneficiaries to the hospital. Beauchamp, the feds allege, asked Loter to then sell those Medicare referrals to another hospital for $350 a patient.

Loter was essential to helping the hospital get around federal anti-kickback statutes because his advertising firm could easily accept payments from Unique Healthcare and Adelaide Business Solutions, two shell corporations setup in order to allegedly funnel money to doctors and other health professionals who funneled patients to or performed procedures at Forest Park Medical Center.

He will be sentenced to five years probation for his guilty plea to misprision, or intentional concealment, of a felony and testimony against his co-defendants.

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