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.
In addition to his prison term, Mr. Thompson, an internist who operated a medical clinic in Delray Beach, was ordered to pay $2.1 million in restitution.
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