Chelation Therapist Charged with Insurance Fraud

Stephen Barrett, M.D.

A federal grand jury has charged Scott Rulon Werner, MD, of Cedar City, Utah, with 54 law violations in a scheme to defraud Medicare, Medicaid, and private insurance companies. According to the indictment, Werner falsely represented on insurance claim forms that he had provided IV services when he had actually performed chelation therapy for ailments for which chelation therapy is not approved for use [1]. Insurance plans pay in response to claim forms that contain code numbers for the patient's diagnosis and treatment. If the codes are compatible and the type and amount of service do not fall outside of the company's payment parameters, the claim will be processed with little or no human review. Because chelation is approved only for treating heavy metal poisoning, some chelation therapists who use it for cardiovascular disease or other conditions attempt to disguise what they do. According to the indictment, Werner not only used improper codes but also attempted to modify patient records when he thought he was being investigated. The pertinent portions of indictment state:

THE SCHEME AND ARTIFICE TO DEFRAUD 32. From in or around December 1997 to in or around March 2002, Scott Rulon Werner, M.D., defendant herein, knowingly and willfully devised and intended to devise a scheme and artifice to defraud public and private health care benefit programs and to obtain money from such programs by means of false and fraudulent pretenses, representation, and omissions, in that the defendant submitted false claims representing that he had rendered IV therapy services for beneficiaries, when in truth and fact the defendant rendered chelation therapy services for beneficiaries, resulting in payments from health care benefit programs to which the defendant was not entitled. 33. It was part of the artifice and scheme to defraud that the defendant recommended and performed chelation therapy services for beneficiaries who presented with various illnesses and symptoms other than those associated with heavy metal toxicity. 34. It was further part of the artifice and scheme to defraud that the defendant authorized and directed clinic personnel, through the use of a superbill form, verbal instructions or other related documents, to prepare a HCFA 1500 claim requesting reimbursement for services using the following CPT codes, among others, or combinations thereof, for the reasons indicated below: a. CPT 99213 - Defendant's use of this code indicated an established patient, level 3 office visit. b. CPT 90780 - Defendant's use of this code indicated the patient received one hour of IV therapy. c. CPT 90781 - Defendant's use of this code indicated the patient received additional hours of IV therapy. d. J7042 - Defendant's use of this code indicated the patient received a saline solution as part of his IV therapy. e. J3420 - Defendant's use of this code indicated the patient received a vitamin B-12 solution as part of his IV therapy. f. J2000 - Defendant's use of this code indicated the patient received a xylocaine solution as part of his IV therapy. g. J3475 - Defendant's use of this code indicated the patient received a magnesium sulfate solution as part of his IV therapy. 35. It was further part of the artifice and scheme to defraud that the above claims were submitted to reflect falsely that a beneficiary had received IV therapy services when in truth and fact the beneficiary had received chelation therapy services. The information contained in the HCFA-1500 claims prepared at the defendant's direction and control failed to disclose any information which would have put the public and private health care benefit programs on notice that the defendant has performed chelation therapy services for their respective beneficiaries. 36. It was further part of the artifice and scheme to defraud that the above claim were submitted to public and private health care benefit programs by U.S. mail or electronically. ACTS IN FURTHERANCE OF THE ARTIFICE AND SCHEME TO DEFRAUD In furtherance and to effect the objectives of the artifice and scheme to defraud, the following acts, among others, were committed in the Central District of Utah: 37. During in and around 199, the defendant, o clinic personnel acting at the defendant's direction and control, began altering patient chart entries from "chelation therapy" to "IV therapy." The changes were made in different ways, including among others: (a)placing a sticker containing a false chart entry for "IV" over a chart entry for "chelation" therapy; and (b) revising the chart entry template on the clinic's computer from "chelation" therapy services to "IV" therapy services. The foregoing protocol was either in effect or implemented shortly after the clinic was served on or around September 20, 1999 with a Medicaid subpoena for records relating to specific beneficiaries [2].

References

1. Doctor charged in 54-count indictment with health care fraud, false claims, other federal violations. DOJ news release, Nov 26, 2003.
2. United States of America v. Scott Rulon Werner, M.D. Indictment. U.S. District Court, District of Utah, Central Division, Case number 2:03CR00907 DAK, Nov 25, 2003.