Delray Beach Doc Accused of $2.1M Medicare Scam

DELRAY BEACH, FL – A Delray Beach doctor is facing serious allegations of bilking Medicare out of over $2.1 million through a scheme to inflate patient diagnoses. Isaac Kojo Anakwah Thompson, M.D., 55, has been charged with eight counts of health care fraud, federal prosecutors announced today.

According to the indictment, Thompson operated two clinics – Isaac K. A. Thompson, M.D., P.A. in Delray Beach and IM Medical P.A. in Boynton Beach – both designated as Primary Care Physicians (PCPs) within Humana’s HMO network. This allowed beneficiaries enrolled in Humana Medicare Advantage plans to select Thompson’s clinics as their PCP. Humana reportedly paid each clinic roughly 80% of a ‘capitated fee’ – a fixed payment per enrolled beneficiary.

The feds allege Thompson systematically submitted fraudulent diagnoses to Humana for his Medicare Advantage patients. These inflated claims were then passed on to Medicare, triggering an increase in the capitation payments associated with those patients. The scheme reportedly netted at least $2.1 million in excess payments from Medicare, with Thompson’s clinics receiving approximately 80% of that fraudulent windfall. Crucially, investigators claim Thompson saw no corresponding increase in actual treatment costs for these patients, suggesting the diagnoses were entirely fabricated.

The Medicare Advantage program, as prosecutors outlined, is a voluntary system where Medicare contracts with private insurers like Humana. Instead of paying for each individual service, Medicare provides a fixed monthly fee for each enrolled beneficiary. That fee *increases* based on the beneficiary’s documented medical conditions – meaning sicker patients generate higher payments. The indictment details how Thompson allegedly exploited this system, knowing false diagnoses would trigger higher payments from Medicare through Humana.

Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida, George L. Piro, Special Agent in Charge, FBI, Miami Field Office, and Derrick Jackson, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), jointly announced the charges. If convicted on all counts, Thompson faces a maximum possible sentence of 10 years in prison per count. The investigation was spearheaded by the FBI and HHS-OIG, with the prosecution handled by Assistant U.S. Attorney Marc Osborne.

It’s vital to remember that an indictment is merely an accusation. Thompson is presumed innocent until proven guilty in a court of law. Further details can be found on the U.S. Attorney’s Office for the Southern District of Florida website at http://www.usdoj.gov/usao/fls and court documents on the District Court for the Southern District of Florida website at http://www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov.