Edwardsville physician Phillip J. Greene, 59, pleaded guilty to federal healthcare fraud for documenting false services provided to nursing home patients for Medicare reimbursement.
Greene pleaded guilty to one county of healthcare fraud in the U.S. District Court for the Southern District of Illinois, according to a press release.
“We entrust medical professionals to provide ethical care, but some choose to act in bad faith,” said U.S. Attorney Rachelle Aud Crowe. “I’m thankful to the investigators who uncovered Greene’s fraud and partnered with our office to hold him accountable.
Greene was employed by General Medicine as a practicing licensed physician and was an enrolled provider in the federal Medicare program. He worked at various nursing home locations throughout the Southern District of Illinois.
Greene misrepresented his medical and progress notes for nursing home patients, documenting services he did not perform. His conduct included billed services for patients who were already deceased at the time.
Greene is charged with submitting false claims to Medicare by way of General Medicine, totaling more than $20,000 for false health services from October 2016 to September 2018. Of those claims, Medicare reimbursed Greene and General Medicine more than $15,000 for the falsified claims.
Mario M. Pinto of the U.S. Department of Health and Human Services, Office of Inspector General, was the special agent in charge of the investigation.
“Physicians who submit fraudulent claims in our federal health care programs not only unjustly enrich themselves, but also undermine the trust and confidence of their patients,” Pinto said.
The Department of Health and Human Services previously filed a civil lawsuit against General Medicine in the Southern District of Illinois in 2022 for allegedly engaging in a Medicare billing “scheme” and costing taxpayers millions of dollars. The lawsuit is still pending.
“Defendants have engaged in a years-long, wide-ranging health care fraud scheme that involved billing Medicare for thousands of false claims for visits with nursing home and assisted living facility residents,” assisted U.S. attorney Steven Weinhoeft wrote in the lawsuit.
“These claims were false because the associated patient visits were either not performed, not medically necessary, or insufficient to meet the requirements of the billing code for which reimbursement was received. Defendants’ unlawful scheme netted tens of millions of dollars in payments, with American taxpayers footing the bill,” Weinhoeft added.
The civil complaint alleges that several General Medicine shell companies agreed to execute the healthcare fraud scheme with General Medicine serving as the dominant public front of the company. She shell entities were allegedly used to employ clinicians in various states or to bill Medicare for services performed by employees of General Medicine and other shell entities.The alleged conduct began as early as Jan. 1, 2013.
The defendants allegedly billed as many patient visits as possible and submitted inflated claims in an effort to bill at the highest possible rates.
Greene’s sentencing is scheduled for June 5 at 10:30 a.m. Healthcare fraud is punishable by up to 10 years imprisonment, a fine of up to $250,000, and up to three years’ supervised release. Greene is also required to pay restitution for the government’s losses.