United States Attorney David E. Nahmias said, `This sentence is another reminder that health care providers who fraudulently bill for their services will be held accountable for their crimes. These defendant and his partners received millions of dollars to which they were not entitled, by lying to insurers about the services they were providing patients. Such lies contribute to the problem of soaring health costs for all, and those responsible may end up spending years in prison.`
STEARNS was sentenced to serve five years in federal prison, to be followed by 3 years of supervised release. There is no parole in the federal system. He was also ordered to pay $1.2 million in restitution.
According to United States Attorney Nahmias and the information presented in court: In 2004, STEARNS and two partners, fellow chiropractors STEVEN LEVINE and CHRISTOPHER TOPEL, operated three clinics around the Atlanta area under the name Comprehensive Care Medical Group (`CCMG`). CCMG, under the direction of STEARNS, fraudulently billed Blue Cross/Blue Shield of Georgia for two separate back pain procedures, costing that insurer alone approximately $2 million.
First, STEARNS and his partners fraudulently billed for a procedure
known as Vertebral Axial Decompression ("VAX-D") -- a non-invasive back
pain procedure that uses a mechanical table to stretch a patient's
spine. Blue Cross/Blue Shield of Georgia considers VAX-D to be
investigational and not medically necessary, and made clear to health
care providers that it did not cover the procedure. STEARNS, along with
LEVINE and TOPEL, were convicted of having lied to Blue Cross about
what procedures they were performing in order to get paid for this
non-covered procedure. Specifically, instead of using the specific
billing code assigned to VAX-D, CCMG used a different code that
pertained to surgical nerve decompression procedures. The Indictment
charged that STEARNS used that code because he and the others knew Blue
Cross would pay for it, and would not pay for VAX-D. The proof at trial
included testimony from the STEARNS' former employees, several of whom
were explicitly instructed to not refer to the procedure as `VAX-D` in
patient files.