Charge: KY clinics billed feds, patients for same drug treatment, banked $3 million
A man who owned substance-abuse treatment clinics in Eastern Kentucky illegally billed patients and Medicaid for the same services, a federal grand jury has charged.
The grand jury indicted Eugene Sisco III on one charge of wire fraud and one charge of health fraud on Thursday.
Sisco, 35, of Pikeville, owned outpatient clinics in Pike, Floyd and Harlan counties where people received buprenorphine — commonly called Suboxone — to deal with addiction to opioid drugs such as pain pills.
Buprenorphine is used in treatment to reduce withdrawal symptoms.
Sisco’s clinics charged people $200 to $300 in cash for services, particularly physical examinations, but also billed Medicaid for that work, the indictment charged.
When employees and contractors questioned the legality of the practice, Sisco allegedly lied and said the cash payments were for counseling or drug testing that Medicaid wouldn’t cover, when he knew the program would reimburse for providing counseling to patients.
Sisco also had a drug-testing lab called Toxperts. He required patients to provide a urine sample for testing on each visit to a clinic, then sent the samples to his lab for analysis, the indictment said.
Sisco had the lab bill Medicaid for drug tests that patients had already paid for, the indictment charged.
The wire fraud charge against Sisco alleges he filed false claims with Medicaid, while the health fraud charge alleges that he submitted bills for urine drug tests that were not necessary.
Sisco deposited more than $3 million in cash from patients in the bank during the scheme, the indictment said.
The wire fraud charge, which has a maximum sentence of 20 years in prison, covers the period from May 2016 to October 2019. The health fraud charge covers from June 2016 to February 2020.
The clinics involved were called Renew Addiction Treatment Clinic LLC, also known as Behavioral Health Professionals, the indictment said.
Sisco also operated Renew Residential Treatment Services, also known as Brookside, which has a residential treatment facility in Pike County; Alcohol and Substance Abuse Professionals LLC; and ASAP Addiction Treatment LLC, according to the indictment.
