Sore Feet

An Illinois attorney has filed a motion for consent disbarment in the wake of her September plea in the United States District Court for the Eastern District of Missouri to a health care fraud involving foot treatment.

The indictment alleged 

The Medicare Program reimburses health care providers, including podiatrists, for certain medically necessary foot care services provided to eligible beneficiaries. Medicare pays providers directly or pays the employer, if the provider has assigned the payments to the employer.

The Medicare Benefit Policy Manual (hereafter Medicare Manual) sets forth the Medicare rules for what services are covered and will be reimbursed by Medicare. With few exceptions, the Medicare program does not pay for routine foot care. The Medicare Manual states that the “services that normally are considered routine and not covered by Medicare include the following:

• The cutting or removal of corns and calluses;

• The trimming, cutting, clipping, or debriding of nails; and

• Other hygienic and preventive maintenance care, such as cleaning and soaking the feet, the use of skin creams to maintain skin tone of either ambulatory or bedfast patients, and any other service performed in the absence of localized illness, injury, or symptoms involving the foot. 

The conspiracy involved alteration of treatment records to falsely reflect reimbursable services, such as

On November 10,2011, the DON of Parkside Care Center complained to Aggeus’ marketer lL. about the podiatry notes from the October visit. The DON stated: “The statement concerning patient M.M. being alert and oriented x3 is not true on any day. She cannot put words together to complain about toenails.”

On February 21,2012, Dr. A.B. treated C.B. and created a progress note that falsely stated that the patient presents ambulatory. The note further falsely stated “the patient or staff request treatment because the nails are painful to such a degree as to affect ambulation and balance.”

On April 25,2012, Dr. J.D., another Aggeus podiatrist, treated C.B. and created a progress note that falsely indicated C.B. presented ambulatory. The note further falsely stated that “the patient or staff requested treatment because the toenails are so painful as to affect ambulation or balance.”

On May 8, 2012, 13 days after his previous visit, Dr. J.D. treated C.B. and created a progress note that falsely stated the patient presents ambulatory. The note further noted “the patient or staff requested treatment because the toenails are painful as to affect ambulation and balance.”

From the motion

On September 14, 2016, Movant entered into a voluntary plea of guilty to Count One, which charged that from January 1, 2009 through September 25, 2015, Movant, her husband Dr. Yev Gray (“Gray”), and a former CEO and manager James Sayadzad (“Sayadzad”) conspired to defraud health care benefit programs, in violation of Title 18, United States Code, Section 371. Movant’s sentencing before United States District Court Judge Ronnie L. White is scheduled for December 15, 2016.

As part of that plea agreement, Movant admitted that her husband was a licensed doctor of podiatric medicine, a provider in the Medicare program, and president of Aggeus Healthcare, P.C. (“Aggeus Healthcare”) and Aggeus Healthcare, LLC (“Aggeus Global”) Sayadzad was the chief executive officer of Aggeus Healthcare and manager of Aggeus Global. Both Gray and Sayadzad owned Aggeus Healthcare and Aggeus Global (“Aggeus”)

Movant admitted that she was the director of corporate and legal affairs for Aggeus Healthcare, and that she supervised the company’s billing, finance, and accounts receivable departments.

In her plea agreement, Movant acknowledged that she knowingly joined an agreement to defraud the Medicare program and to make materially false, fictitious and fraudulent statements with respect to the Medicare program, in violation of Title 18 United States Code, Section 371.

In that plea agreement, Movant acknowledged that she and the other codefendants and their employees and contract podiatrists at their direction, created and caused the creation and use of false and fraudulent patient medical records and other documents.

Specifically, Movant admitted that Aggeus contracted with skilled nursing facilities to provide podiatric services to residents of long term care or assisted living facilities in at least 16 different states. In Missouri, Aggeus provided podiatric services to residents in at least eleven facilities, that Aggeus contracted with podiatrists to provide the podiatric services, that Movant’s co-defendants encouraged and pressured those podiatrists to provide services that were medically unnecessary. Movant and Gray also established an electronic medical record system that they knew would sometimes produce inaccurate progress notes to increase the likelihood of receiving Medicare reimbursement for services.

Movant also admitted that she, Gray and Sayadzad, and their employees and contractors, submitted and caused the submission of false and fraudulent reimbursement claims to Medicare; and that they either did not disclose, or actively concealed, that Aggeus had billed and been paid for services that were not provided or were not covered by Medicare, and did not return the overpayments to Medicare.

Although Movant acknowledged that the loss amount attributable to her participation in the conspiracy was difficult to determine, she stipulated that the amount of restitution was $990,061.

That’s a lot of feet. (Mike Frisch)