(The Center Square) – The co-owner of a health care company was sentenced to 20 months in prison and fined $100,000 for submitting $3.8 million in fraudulent claims to government health care benefit organizations.
Carlos Himpler, 44, plead guilty earlier this year to a felony conspiracy charge and was sentenced on Tuesday by U.S. District Judge Sarah Pitlyk. Dr. Franco Sicuro, Himpler’s partner and co-defendant, pleaded guilty in November 2022 and agreed to forfeit $3.1 million in assets.
In the plea agreement, Himpler admitted Medicare, Medicaid and private health care insurers paid $1.4 million in illegal pass-through billing and $2.4 million in split billing.
Himpler owned or operated a series of health-care related businesses. In 2014, Himpler and Sicuro opened an in-house testing lab at Sicuro’s company, Advanced Geriatric Management LLC in Creve Coeur, Mo. They also opened another clinical testing laboratory, Genotec, in the same building and used the same testing machine as Advanced Geriatric Management.
The pair concealed Sicuro’s co-ownership of Genotec from Medicare, Medicaid and other private health insurers. Sicuro also referred the testing of urine specimens to Genotec. Himpler, Sicuro and other health care providers at Advanced Geriatric Management ordered urine toxicology tests for patients and referred the patients to their labs, which in turn sent the sample to outside laboratories. Himpler admitted their companies didn’t have the necessary testing equipment and billed health insurers for the testing, which is considered “pass-through billing.”
When health insurers started to question Genotec claims for payment, Himpler and Sicuro created another laboratory company for billing the insurers. The laboratory, Midwest Toxicology group, wasn’t authorized to perform tests, didn’t have the appropriate certification or any lab equipment. Investigators discovered Himpler had Genotec and Midwest each submit claims for testing of the same specimen obtained from the same person on the same day.
“Today’s sentencing of Dr. Carlos Himpler demonstrates that the Health and Human Services-Office of the Inspector General will continue to hold individuals who exploit federal health care programs accountable,” Linda T. Hanley, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General, said in a statement. “Health care providers have a responsibility to submit accurate and honest claims to federal health care programs, to ensure that these resources are available for eligible patients.”