CONWAY, SC (WMBF) – Two chiropractors who practiced in Conway were each charged with conspiracy to commit health care fraud by a Grand Jury in Florence, according to a news release from the U.S. Attorneys Office.
John Andrew Pienkos II, 46, of Little River, and Alexander Tomovski, 49, of Murrells Inlet, both of whom practiced in Conway, were charged, the release states.
The chiropractors could each face a penalty of up to 10 years in prison and a potential fine of $250,000, according to U.S. Attorney Beth Drake.
The indictment states that the sum of all money equal to the proceeds obtained by Pienkos and Tomovski from offenses related to the charge is a minimum of $399,289.83.
Pienkos and Tomovski allegedly defrauded Blue Cross Blue Shield of South Carolina (BCBSSC) by implementing a financial plan with their chiropractic patients that waived their co-payments and deductibles in exchange for a flat fee per month, usually between $10 and $50, the indictment states. In exchange for the plan, their patients were required to visit the clinics, at Conway Health Care and Allied Health Care, until they reached their health coverage policy limits, often two or three times per week, regardless of medical necessity. After reaching the limits, the patients were entitled to one free visit per month, and had to pay out-of-pocket for the rest.
Therapy assistant and administrators were instructed to bill for the time and procedures on “travel cards” given to each patient, whether the serves were rendered and accurately accounted or not, resulting in excessive billing to BCBSSC, the indictment continues.
It patients opted out of the financial plan before exhausting their policy limits, Pienkos and Tomovski could charge them their full per visit co-pays and deductibles. The chiropractors regularly charged for services that were not rendered, and billed as though Pienkos saw the patients, even when he did not.
From 2012 to 2016, Pienkos and Tomovski, through Conway Health Care, charged about $2.6 million in submissions to BCBSSC and were paid about $1.7 million. Through Allied Health Care, they charged over $431,000 and were paid about $263,609, the indictment alleges, adding that at least 20 percent of those billings were fraudulent.
The FBI and the United States Postal Service investigated the case, the release states. Assistant U.S. Attorney Winston David Holliday, Jr., of the Columbia office, is prosecuting the case.
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