Orthopedist Indicted for Healthcare Fraud


An indictment filed by the United States claims a fire that destroyed a Texas orthopedist’s home was started to destroy evidence of a healthcare fraud scheme.

In October 2017, a fire destroyed the $1.6 million Fort Worth home of Mark Kuper, D.O. and his wife Melissa Kuper (Melissa). The fire spread from an outdoor fireplace where firefighters purportedly found charred and burned medical and billing records.

The fire occurred a year after a claim was brought against Dr. Kuper for violations of the False Claims Act and the Texas Medicaid Fraud Prevention Act. Dr. Kuper owned Texas Center for Orthopedic and Spinal Disorders (TCOSD). TCOSD had two locations in Fort Worth and Weatherford.

In May 2020, the United States and Texas filed complaints in partial intervention in the action. The intervener complaint alleges Dr. Kuper and TCOSD submitted over 100,000 fraudulent claims to federal healthcare programs. The complaint asserts that Dr. Kuper billed federal programs for over 100 hours in a single day on 139 different occasions.

A month later, the United States filed an indictment against Dr. Kuper, Melissa, and Travis Couey. Melissa reportedly worked in management roles at both locations. Couey was a licensed physical therapist at both locations.

In the indictment, the United States alleges that from 2014 through 2017 the defendants engaged in fraudulent healthcare billing that took advantage of patients who were “underserved, disadvantaged, and elderly.” The government claims the defendants submitted claims for “over $10 million to Medicare, Medicaid, and TRICARE for services that were not rendered.”

In support of the fraud claim, the United States asserts Dr. Kuper billed for 60-minute psychotherapy sessions when he only saw patients for 15 to 20 minutes. In many instances the government alleges that Dr. Kuper was not even at the clinic during the patient visits. Additionally, Couey purportedly “helped to create and maintain false medical records” for services he never rendered.

The United States does not believe that those treating patients for psychotherapy appointments were trained to provide such services. In support of this claim, the government pointed out that Dr. Kuper himself was only trained in orthopedics, not psychotherapy.

The indictment emphasized that Dr. Kuper personally billed times for services not possible in a 24-hour window. The government claims that in one instance Dr. Kuper billed for 140 hours of medical services in a 24-hour day.

The United States also asserts the defendants prescribed highly addictive controlled substances to patients to ensure patients would return for treatment. The United States contends that Melissa illegally dispensed and authorized prescriptions for controlled substances. She is not a licensed medical provider.

On June 22, 2020, the defendants appeared in court and entered pleas of not guilty. A jury trial is set for July 27, 2020.

Source: https://ryortho.com/breaking/fort-worth-orthopedist-indicted-for-healthcare-fraud/

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