Kentucky pain doctor to pay $20 million over allegations of false billing

A doctor who had pain-management clinics in several Kentucky cities has agreed to pay $20 million to settle allegations of submitting false bills to insurance programs.

The U.S. Department of Justice announced the settlement against Robert E. Windsor Wednesday.

Windsor, who lives in Georgia, owned pain-management clinics there and in Kentucky that operated under the umbrella of National Pain Care, Inc., according to a news release from the Department of Justice.

The Kentucky clinics were in Lexington, Somerset, London, Hazard, Prestonsburg and Pikeville.

Windsor allegedly billed federally funded health care programs such as Medicare and TRICARE for services he did not perform.

Windsor agreed to provide intraoperative monitoring, a procedure in which a physician monitors nerve and spinal cord activity online during surgery to guard against adverse effects to a patient’s nervous system, according to a court record.

There were times when Windsor had unqualified assistants monitor surgeries but submitted bills saying he did the work, the government alleged.

That scheme took place between January 2008 and July 2013.

Federal authorities also alleged that between January 2010 and June 2014, Windsor took part in submitting false claims to Medicare, the Kentucky and Georgia Medicaid programs, and other insurance providers for medical tests and procedures that were not necessary.

“Dr. Windsor placed personal gain above all else in his medical practice,” said Carlton S. Shier, IV, acting U.S. Attorney for the Eastern District of Kentucky. “In doing so, he put his patients at risk, and defrauded the United States.”

Windsor pleaded guilty to two charges of health care fraud last year and was sentenced to three years and two months in prison, and ordered to pay more than $1 million in restitution, according to a court record.

He is to report to prison next month.

Whistleblower lawsuits in Kentucky and Georgia ultimately led to the agreement for Windsor to pay $20 million.

In Kentucky, Drs. Stephanie Herder and Bradley Davis filed a lawsuit alleging fraud by Windsor and will share in the settlement.

Herder had been an employee of Windsor’s and saw problems in the clinic, said Lexington attorney Brandon Wayne Marshall.

Herder brought the whistleblower complaint because she cares about patient safety and the integrity of the health care system, Marshall said.

“She is a patient-first kind of doctor,” he said.

Windsor, who is in his mid-50s, agreed to sell most of his commercial and residential properties and other assets, such as boats and personal watercraft, to try to settle the $20 million judgment.

This story was originally published February 1, 2017 at 5:55 PM with the headline "Kentucky pain doctor to pay $20 million over allegations of false billing."