A Baton Rouge, Louisiana, spine and sports doctor has been sentenced to 37 months in prison for his role in a scheme to defraud Medicare and other health care insurers.
Louisiana Spine and Sports Doc Imprisoned for Medicare Fraud
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John Eastham Clark, M.D., 66, was the co-owner and medical director of Louisiana Spine & Sports LLC, a pain management clinic located in Baton Rouge, Louisiana.
Clark’s case was investigated by U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) and the FBI and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana.
Assistant Chief Dustin M. Davis and Trial Attorney Justin M. Woodard of the Fraud Section and Assistant U.S. Attorney Elizabeth E. White of the Middle District of Louisiana were prosecutors on the case.
In February 2019, Clark pleaded guilty to one count of conspiracy to commit health care fraud.
Clark was charged for his role in a scheme to submit fraudulent claims to Medicare and other health care insurers. As part of his guilty plea, Clark admitted that from approximately June 2005 through March 2015, he conspired to submit fraudulent claims indicating that minor surgical procedures occurred on days subsequent to office visits, when in fact the office visits and procedures took place on the same day.
Clark admitted that his actions, commonly known as “unbundling,” were done to defraud health care insurers for non-reimbursable office visits. Clark also admitted to falsifying, and directing others to falsify, records substantiating the fraudulent claims.
Clark was sentenced by Chief U.S. District Judge Shelly D. Dick of the Middle District of Louisiana. Judge Dick also ordered Clark to pay $254,962.80 in restitution. In addition to his 37 months in prison, Clark was also sentenced to serve two years of supervised release after his prison sentence is complete.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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