Isaac Kojo Anakwah Thompson, MD, of Delray Beach, Fla., has pleaded guilty to one count of healthcare fraud for engaging in a scheme to defraud the Medicare Advantage program, according to the Department of Justice.
Medicare pays the sponsoring insurance company a capitated monthly fee for each beneficiary who chooses to enroll in a Medicare Advantage plan. The fixed fee is adjusted based on the beneficiary's medical conditions. As a result, Medicare typically pays a larger capitated fee for a beneficiary with more serious medical conditions than it does for a healthier beneficiary.
Between 2007 and 2010, Dr. Thompson defrauded Medicare by falsely diagnosing 387 Medicare Advantage beneficiaries with ankylosing spondylitis, a rare chronic inflammatory disease of the spine. The false diagnoses were reported to Humana, which then reported them to Medicare. As a result, Medicare paid approximately $2.1 million in excess capitation fees, about 80 percent of which went to Dr. Thompson, according to the DOJ.
Sentencing for Mr. Hill is scheduled for May 18. He faces up to 10 years in prison.
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