AMARILLO, Texas — Thomas Roy Clark, 52, of Bushland, Texas, pleaded guilty today to one count of health care fraud stemming from a scheme to defraud insurance companies through the submission of improper billing. The announcement was made today by U.S. Attorney John Parker of the Northern District of Texas.
Clark, who remains on bond, faces a maximum statutory penalty of 10 years in federal prison, a $250,000 fine, and may be ordered to pay restitution. Sentencing is scheduled for November 29, 2017, before U.S. District Judge Sidney A. Fitzwater.
According to documents filed in the case, from July 1, 2012 through July 31, 2015, Clark operated Panhandle Chiropractic Clinic (PCC) in Amarillo, Texas, without a license issued by the Texas Board of Chiropractic Examiners. Clark devised a scheme to defraud a health-care benefit program, to obtain money by billing for services properly billable only by a licensed chiropractor, services not rendered and for services rendered in lesser quantities billed.
Clark also billed insurance companies for services under the name of a licensed chiropractor for services allegedly rendered by Clark. Clark would omit his name on PCC’s itemized billing statements, which prevented insurance companies from knowing they were being billed for services provided by a chiropractor without a license. Clark also listed the specific type of procedure or service PCC provided by specifying a Current Procedural Terminology (CPT) code. By using CPT codes, this misrepresented to insurance companies that the procedures being billed were performed by a licensed health care provider in good standing with their state board.
As a result of the scheme Clark fraudulently induced health care providers to issue monetary payments to PCC, resulting in billing and payment for approximately $524,547.89 from 12 insurance companies.
The Federal Bureau of Investigation investigated. Assistant U.S. Attorney Joshua Frausto is prosecuting.
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Department of Justice
Office of the U.S. Attorney
Northern District of Texas