Issue link: https://beckershealthcare.uberflip.com/i/1293265
15 SPINE SURGEONS Spine surgeon, distributor to plead guilty in kickback scheme that used $4.5M of device company's products, says DOJ By Alan Condon L awson, Mo.-based spine surgeon Jason Montone, DO, and distributor John Balzer of Lenexa, Kan., have agreed to plead guilty to charges of conspiring to pay and receive kickbacks and obstructing the U.S. Department of Justice's investigation into that kickback scheme. Dr. Montone will plead guilty to one count of conspiracy to violate the Anti-Kickback statute and one count of obstruc- tion, according to an Aug. 18 news release from the DOJ. Mr. Balzer will also plead guilty to one count of conspiracy to violate the Anti-Kickback statute and one count of wit- ness tampering. The kickback scheme involved an unnamed medical de- vice company that paid Dr. Montone $379,000 in "sham consulting fees" between late 2012 and October 2015, ac- cording to the DOJ news release. Investigators said the surgeon received $500 to $750 per hour for "supposed consulting services" and used more than $4.5 million of the company's spine products. Several of the surgeries Dr. Montone performed during this time were on Medicare or Medicaid beneficiaries. The company agreed to pay Mr. Balzer a 25 percent com- mission on all of its products that Dr. Montone used, ac- cording to the DOJ, and received more than $1.2 million in commissions. Dr. Montone allegedly created and produced false docu- ments to the federal government to demonstrate work he performed in accordance with the consulting agreement. Mr. Balzer, on the other hand, allegedly advised Dr. Mon- tone to falsely tell investigators that he had performed legitimate consulting services equal to the hundreds of hours they had reported. The DOJ is proposing sentences on the low end of the sen- tencing guidelines for both individuals. It is also recommending that Dr. Montone forfeit $379,000 — the amount he received in "sham consulting fees" — and Mr. Balzer forfeit $1,264,501, which is the amount he re- ceived in commissions from the medical device company for products Dr. Montone used. n REVENUE CYCLE REDEFINING THE 2019 2019 For guidance during this unique time, visit our Industry Insights page for the latest news, webinars, blogs, and resources. www.nationalascbilling.com/industry-insights 866-948-7673 • nationalASCbilling.com REVENUE CYCLE MANAGEMENT | MANAGED CARE CONTRACTING | CODING | BUSINESS ANALYTICS | CONSULTING | TRANSCRIPTION THE ASC REVENUE CYCLE. It's all we do. It's all we think about. And it shows.