Louisiana Doctor Indicted for Billing Medicare for Unnecessary Urinalyses

The DOJ alleges Dole billed Medicare for over $32.7 million and received more than $11.7 million for medically unnecessary comprehensive drug tests for his patients.

A federal grand jury returned the indictment on Sept. 18 in U.S. District Court in Lafayette. Federal prosecutors said Dole, 59, owned and operated a pain management practice with an in-house drug testing laboratory, which he co-owned with an unnamed co-conspirator, according to the indictment.

Dole is charged with one count of conspiracy to commit healthcare fraud and five counts of healthcare fraud. If convicted, he faces a maximum penalty of 10 years in prison on each count – up to 60 years total – and could be required to reimburse the money he received.

The government also asks that he forfeit any property or personal items purchased with the money he received from fraudulent claims. If that property or purchase is not available to be forfeited, Dole must forfeit “any other property of the defendant up to a value of the forfeitable property.”

Defense Attorney’s Comments

Dole’s attorney, J. Michael Small of Alexandria, told The Daily Muck that Dole will plead not guilty to the conspiracy to defraud and five specific fraud charges when he appears before U.S. Magistrate Judge Joseph Perez-Montes on Sept. 26.

“The federal folks contend that the services performed by Dr. Dole and billed to Medicare were medically unnecessary and therefore should not have been billed for,” Small said. “Dr. Dole, on the other hand, contends that due to the nature of his patient base, the medical tests he performed were not only necessary but essential for his patients’ well-being.”

The attorney said the dispute between prosecutors and his client “while significant, is not complicated.”

“I am confident that after all facts are made known to a federal court jury, my client will be found not guilty of these charges,” Small said.

Details of Indictment

The DOJ emphasized the indictment “is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.”

In its press release, the DOJ states that from January 2010 to July 2023, Dole allegedly billed Medicare over $32.7 million for “testing of routinely over 22 classes of drugs in urine specimens from nearly all his patients, despite a lack of documentation of use or suspicion of use of those drugs by the patients.“

The indictment, reviewed by The Daily Muck, states Medicare reimbursed Dole over $11.7 million for medically unnecessary urine drug testing claims, and he used the proceeds “on personal expenses, including, among other things, international trips, use of a private jet, and to purchase jewelry.”

The indictment sets the stage for the charges by noting that Medicare Part B covers “medical items and services that were reasonable and medically necessary.” It goes on to explain why the government believes the services billed were not reasonable and necessary.

It says Medicare covers urine drug testing when it is “for the diagnosis or treatment of illness or injury and when it was ordered by a physician who was treating the beneficiary and who used the results of the testing in the management of the beneficiary’s specific medical problem.”

Allowable reasons for urine drug tests include determining “whether a patient was taking drugs that might interfere with a planned medical treatment, or to ensure that a patient was compliant with a prescription regime.”

Two Types of Tests

There are two types of drug tests. “Presumptive,” or drug screens, identify whether any substances are in the urine. If that test is positive, a “definitive” test can be taken to determine the levels of substances.

“Definitive tests were typically administered after presumptive tests, with limited exceptions made for certain substances, such as certain synthetic opioids, that were not included in drug screens,” the government explained in the indictment. “Where a presumptive test produced an inconsistent or unexpected result for a particular substance, Medicare considered a definitive test to be medically necessary and appropriately reimbursable for that particular substance.

“Medicare would generally not reimburse providers for confirming results of presumptive tests that were consistent or expected, or for standing and/or blanket orders of definitive tests,” the indictment added.

Prosecutors say Dole’s actions did not fall within those allowable parameters.

“Dole required that all patients submit to urine drug testing, and he repeatedly billed for conducting both presumptive and definitive testing for beneficiaries, which he often ordered simultaneously,” they allege.

He supposedly maintained pre-filled requisition forms that were not individualized for each patient and ordered a comprehensive test “for nearly all beneficiaries without regard for the presumptive test results.”

Instead of billing for just the drugs the screening indicated were too high, Dole “routinely billed for definitive testing of over 22 classes of drugs, despite a lack of documentation of use or suspicion of use of those drugs.” This included a drug “that was withdrawn from the market years earlier.”

The indictment claims Dole did not use the test results to manage the patient’s specific problem.

The government also alleges Dole “upcoded” his billing for office visits, using a code for “established patient office visits that lasted for 30 minutes or more” when patient interactions with Dole or his nurse practitioners lasted only five to 15 minutes.

Besides the count for conspiracy to defraud, Dole faces only five individual charges of actual fraudulent claims – despite the allegation that it was rampant for 13 years for almost every patient.

Each claim cited in the indictment was for a urine drug test for 22+ substances for a cost of $590. Of course, that is less than $3,000 of the alleged $11.7 million Medicare paid for those drug test claims.

Healthcare Fraud Strike Program

The DOJ’s Health Care Fraud Strike Force Program consists of nine strike forces operating in 27 federal districts. Since its formation in 2007, the initiative has charged more than 5,400 defendants who billed federal health care programs and private insurers more than $27 billion, the DOJ said in its press release.

For more information on the federal government’s anti-fraud efforts, visit here. For more articles providing detailed information about this and other important topics, subscribe to The Daily Muck.