Dr. Jeffrey Sponseller from Augusta, admitted to defrauding Medicare and other government health care programs from January 2008 through 2010. The court heard 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 documentation collected from Dr. Sponseller’s office and nursing homes was completely inadequate for such billing, and in fact was so minimal 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 17 patients. At a nursing home, he 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 didn’t have eyes.
Judge J. Randal Hall said, “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. But it’s a crime against all taxpayers who must pay for care of the elderly and disabled covered by Medicare.”
