A pair of Rhode Island health care executives have been charged with raking in nearly $1.9 million in fake treatment claims, federal authorities announced this week.
Brandon Nowak, 32, of Providence, and Jason Simmons, 32, of Foster, co-owners of Alternative Integrated Medicine, LLC (doing business as AIM Health), appeared in federal court on charges of health care fraud conspiracy, health care fraud, and filing false claims. The defendants were released on unsecured bond.
AIM Health is based in Warwick, with satellite offices in Pawtucket, North Kingstown, and East Providence. Nowak serves as President and CEO, while Simmons acts as the Vice President, Chief Financial Officer, and Compliance Officer.
According to a federal complaint, Nowak directed the submission of claims for services that didn’t occur or weren’t covered, including infrared therapy, hot and cold therapy, and self-care/home management training. The company allegedly modified codes on reimbursement forms to avoid triggering automatic denials.
The scheme involved billing for high complexity office visits without providing that level of service, and even submitting claims for acupuncture and evaluation and management office visits when the actual services provided were massages given by licensed massage therapists.
As a result of this conduct, it is alleged that AIM Health fraudulently obtained $1,872,330 in payments from government and private insurers to which AIM was not entitled to receive.
A federal criminal complaint is merely an accusation. A defendant is presumed innocent unless and until proven guilty.
The case is being prosecuted by Assistant United States Attorneys John P. McAdams and Rachna Vyas, with assistance from the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, and the Defense Criminal Investigative Service and the Department of Veterans Affairs-Office of Inspector General.
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Key Facts
- State: Rhode Island
- Agency: DOJ USAO
- Category: Fraud & Financial Crimes
- Source: Official Source ↗
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