State and federal officials have negotiated a plea agreement with the leader of a firm that submitted what officials say were fraudulent bills to public and private insurers for about 200 chiropractors throughout the United States.
The chiropractor, Markell Boulis, has agreed to an arrangement that could lead to to him paying a fine of up to $250,000 and to him serving a statutory maximum of up to 5 years in prison, according to the Ohio Department of Insurance.
The Ohio department helped with an investigation of Boulis and his chiropractic practice management consulting firm, Practice Solutions Inc., that was led by investigators at the U.S. attorney’s office in Columbus, Ohio, and the U.S. Department of Health and Human Services.
Practice Solutions and a sister firm, National Insurance Auditors L.L.C., both based in Pennsylvania, held seminars for chiropractors, then offered to review the chiropractors’ files for billing opportunities missed due to incorrect coding or failures to bill for services, officials allege.
In some cases, correcting past billing errors is legal. Officials allege that many of the back-billed claims filed in the Boulis case were fraudulent.
Officials estimate private insurers and government agencies paid about $1 million on fraudulent back-billed claims submitted by Boulis between 1999 and 2003.
The plea arrangement with Boulis includes an order for him to pay $820,099.24 in restitution to the insurers, officials say.
Richard Jaffe, the Houston lawyer representing Boulis, says Boulis believes that all of the services described in the bills were provided.
“The patients saw the doctor,” Jaffe says.
Practice Solutions tried to take advantage of what it believed to be a genuine ambiguity in the billing rules by helping chiropractors unbundle services that originally were billed in bundled form, Jaffe says.