An optometrist from the United States has been jailed for nearly three years for defrauding the US Medicare system of almost half a million US dollars.
Dr. Jeffrey Sponseller from Augusta Georgia, admitted to defrauding Medicare and other government health care programs from January 2008 through 2010. The court heard that the Medicare billing code Dr. Sponseller used most often was for the most comprehensive exam possible that would be needed for a new and medically complex case.
It heard that the documentation collected from Dr. Sponseller’s office and nursing homes was completely inadequate for such billing, and in fact was so minimal that it wouldn’t qualify for any kind of Medicare payment.
On one day in July 2009, Dr. Sponseller billed Medicare for a 45-minute comprehensive exam on 177 patients in the one eight hour working day. He was the highest recipient of Medicare payments for that billing procedure in the nation – the second-highest recipient billed for less than half of what Dr. Sponseller claimed he did.
On one day in July 2009, Dr. Sponseller billed Medicare for a 45-minute comprehensive exam on 177 patients in the one eight hour working day.
At one nursing home, Dr. Sponseller billed for comprehensive exams of 59 patients in about three hours. Four of those patients told the nursing home director they had never seen Dr. Sponseller, and another patient didn’t have eyes.
In concluding the case, the Judge said a telling factor was that while Dr. Sponseller was billing for a procedure required for a difficult diagnosis or a very ill patient, rarely did he seek payment for follow-up treatment of these patients.
“When it comes to health care fraud, a lot of people look at these types of cases and say, ‘Well, it’s just the government,’ ”said Judge J. Randal Hall. “But it’s a crime against all taxpayers who must pay for care of the elderly and disabled covered by Medicare.”
