DANIEL CASTRO, M.D., a former doctor at the Medical Center of Southeastern Oklahoma in Durant, Oklahoma, has agreed to pay $275,000 to settle allegations that he billed SoonerCare, the Oklahoma Medicaid Program, for surgical procedures that he did not perform or were not medically necessary.
The U.S. Attorney’s Office for the Eastern District of Oklahoma announced the settlement, which resolves allegations that Dr. Castro submitted false claims to SoonerCare for functional endoscopic sinus surgeries (FESS) and related office services. FESS involves the insertion of a nasal endoscope, a thin fiber optic tube, into the nose for a direct visual examination and clearing of the openings into the sinuses.
According to the settlement, Dr. Castro billed SoonerCare for procedures that were not performed as claimed, including endoscopic debridements, which involve the insertion of an endoscope into the nose for a thorough inspection and removal of dried blood and crusting.
Dr. Castro is not the only one paying for his alleged wrongdoing. The Medical Center of Southeastern Oklahoma’s parent company, Healthcare Management Associates (HMA), has agreed to pay $1.5 million to settle allegations that it billed SoonerCare for surgical procedures performed by Dr. Castro and related hospital services that were not medically necessary.
The allegations against Dr. Castro and HMA were raised in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act. The whistleblower, Sandra Simmons, will receive a share of the settlement.
The settlement marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by then Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sibelius.
Since January 2009, the U.S. Attorney’s Office has recovered over $26.7 billion through False Claims Act cases, with over $16.8 billion of that amount recovered in cases involving fraud against federal health care programs.
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Key Facts
- State: Oklahoma
- Category: Healthcare Fraud
- Source: DOJ Press Release â†â€â€
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