Surgeon Gets Just Desserts For Healthcare Fraud
Compliance

Surgeon Gets Just Desserts For Healthcare Fraud

03/15/2021

What is your favorite dessert, something that goes well with barbecue?

Whether it’s pie or vanilla ice cream (or both!), it’s probably not 10 years in federal prison.

That is the just desert dished out to spine surgeon Mark Kuper, D.O. in late February 2021 for his role in a conspiracy to defraud Medicare, Medicaid, and Tricare.

Front and center in the story are Mark Kuper, D.O., and his wife (and errant barbecue pit-master) Melissa Kuper.

The Salad Days

Dr. Kuper, trained as an orthopedic surgeon, initially practiced in that medical specialty, but, apparently, as a result of medical malpractice lawsuits, gave up his surgical practice. Instead, in 2014, he began operating a pain management practice, the Texas Center for Orthopedic and Spinal Disorders (“TCOSD”), from two clinic locations. Mrs. Kuper served as TCOSD’s office manager.

In 2016, a TCOSD employee, Richard Brown, filed an original, sealed whistleblower complaint against Dr. Kuper, alleging a host of False Claims Act violations.

As a result, in spring and summer 2017, the U.S. Department of Health and Human Services and the Texas Attorney General’s Medicaid fraud unit issued subpoenas to Kuper and TCOSD seeking medical and billing records related to federally funded healthcare programs.

It is reported that, after receiving the subpoenas, Dr. Kuper paid his staff overtime to put the practice’s records into cardboard boxes which were then taken by Dr. and Mrs. Kuper to their approximately 7,800 sq. ft. home outside of Fort Worth.

Overcooked

On what was probably a breezy day in October 2017, Mrs. Kuper decided to barbecue some medical records in their home’s outdoor fireplace in a misguided (on multiple levels) attempt to destroy evidence. Apparently forgetting one of the basic rules of starting a fire, she left it unattended. Before long, their mansion was in flames. In no time at all, it burned to the ground.

But not all of the medical records did; firefighters found a recognizable pile of them in the fireplace.

At the end of May 2020, the U.S. Government intervened in the whistleblower suit brought by Mr. Brown. And, on June 17, 2020, both of the Kupers as well as a physical therapist associated with TCOSD practice, Travis Couey, were criminally indicted for conspiracy to commit health care fraud, for health care fraud itself, and for unlawful distribution of controlled substances.

Just Deserts

Three months after the indictment, Dr. Kuper pleaded guilty to one count of conspiracy to commit healthcare fraud. In late February 2021, he was sentenced to 10 years in federal prison.

In connection with his plea, Dr. Kuper admitted:

  • That he fraudulently build insurance for services that were never rendered, including physical therapy and psychotherapy.
  • That patients were required to attend bogus appointments in order to obtain prescriptions for Schedule II controlled substances.
  • That he used a boilerplate template for physical therapy plans although he submitted claims stating that TCOSD developed individualized plans for each patient.
  • That TCOSD billed for one-on-one therapy, even though patients met in groups with a trainer, not a physical therapist.
  • That he gave his wife access to the secure device and passcode he used to sign controlled substance prescriptions, allowing her to improperly dispense pain medications on her own initiative, without his input.
  • That although he billed insurers for professional 60-minute psychotherapy sessions, most patients actually spoke with unqualified professionals for just 15 to 20 minutes – often when he was out of the office.

According to the Department of Justice’s press release, Dr. Kuper billed as though he’d provided more than 100 hours’ work in a single 24-hour day. From 2014 to 2017, he submitted more than $10 million in claims to Medicaid, Medicare, and TRICARE.

The DOJ also stated that Dr. Kuper tried to cover up evidence of the fraud by accessing hundreds of electronic patient records and altering the purported treatment notes to make them appear more comprehensive.

Melissa Kuper pleaded guilty in September 2020 and received an 18 month sentence. Travis Couey, the TCOSD physical therapist, pleaded guilty in September 2020 and received a 36 month sentence.



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