A Lake Charles, Louisiana orthopedic surgeon, Robert Dale Bernauer, Sr., M.D., has pled guilty to his involvement in a workers’ compensation fraud scheme.
Workers’ Comp Fraud Costs Ortho Surgeon $1M+
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According to court documents, Dr. Bernauer owned The Bernauer Clinic based in Lake Charles, Louisiana. He practiced medicine at his clinic “from 1986 until he voluntarily surrendered his medical license in December 2016.”
Per the Department of Justice press release, the trouble began in 2011 and continued through 2017. During that time, Dr. Bernauer participated in a scheme to defraud “both federal and private workers’ compensation insurers” by “over-billing for unnecessary medications provided to workers’ compensation patients.” He reportedly made more than $1,000,000 from the scheme.
According to court documents, the scheme allegedly involved an Arkansas company that recruited Dr. Bernauer to “dispense pain creams and patches to his workers’ compensation patients.” The company purportedly offered him an equal split of the profits from billing insurers. The company allegedly billed insurers “15 to 20 times what the medications actually cost.”
In the plea agreement, Dr. Bernauer admitted to conspiring with at least three other individuals. He also admitted that he and his co-conspirators “knew he did not have a license to dispense medications from his clinic.” Dr. Bernauer pled guilty to one conspiracy count to commit the following crimes: mail fraud, wire fraud, health care fraud, false statement or fraud to obtain federal employees’ compensation, and illegal remunerations.
Dr. Bernauer will have to pay for his crimes. Within 30 days of his plea agreement, he will pay $664,176.30 in restitution to federal agencies. He will also pay $361,096.70 as restitution to other victims of the conspiracy, namely insurers. At a later date, Dr. Bernauer will have to pay his share of $1,025,273 in additional restitution. He will share that obligation with any other co-conspirators who are convicted.
Dr. Bernauer could face up to five years in prison for pleading guilty to the one conspiracy count. He will face sentencing at a later date after the U.S. Probation Office completes a pre-sentence investigation report. The case was prosecuted by Assistant U.S. Attorneys Steven Mohlhenrich and Hunter Bridges.
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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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