Crime

Two doctors are facing federal fraud charges

Two Conway Health Care doctors are facing fraud charges in federal court.

Dr. John Andrew Pienkos II, 46, of Little River, and Dr. Alexander Tomovski, 49, of Murrells Inlet, were charged with conspiracy to commit health care fraud, according to a release from U.S. Attorney Beth Drake.

According to the charge filed against them, the doctors are accused of unlawfully conspiring to defraud Blue Cross Blue Shield of South Carolina of more than $2 million while they worked as chiropractors at Conway Health Care and Allied Health Care.

From 2012 to April 2016, an indictment says, the doctors billed BCBSSC more than $2.6 million in claims and were paid more than $1.7 million under Conway Health Care. Under Allied Health Care, the doctors submitted $431,975.15 in claims and were paid $263,609.88, according to the indictment.

Prosecutors say at least 20 percent of those billing claims were fraudulent.

Pienkos and Tomovski face up to 10 years in prison and potential fines up to $250,000 in addition to more than $300,000 in restitution if convicted on the charge in the Florence federal court, according to the release.

The indictment states Pienkos and Tomovski implemented a financial plan with their patients that waived co-payments and deductibles in exchange for a flat monthly fee ranging from $10 to $50.

“Individual and family plans were offered,” the indictment states. “In exchange for the financial plan, patients were required to visit the clinics of John Andrew Pienkos II and Alexander Tomovski until they reached their health coverage policy limits, often two to three times per week, regardless of medical necessity.”

“After reaching the policy limits, patients were entitled to approximately one free visit per month and had to pay out-of-pocket for the rest,” the indictment states.

Patients were given “travel cards” with specific billing codes after their first exam, according to the indictment.

“Therapy assistants and administrators were instructed to bill for the time and procedures written on the travel cards, whether the services were rendered or not, and whether the time spent with the patients was accurate or not, resulting in excessive billing to BCBSSC,” the indictment states.

“If patients opted out of the financial plan before exhausting their health coverage policy limits,” the indictment says, the doctors could still charge them for the full per-visit co-pays and deductibles due.

Patients had to agree that they would be held responsible for monthly payments even if they stopped coming, according to the indictment.

Prosecutors accuse the doctors of regularly charging for services even when they were not rendered. The indictment says the doctors regularly billed patients whether they were seen or not.

The doctors are set to be arraigned on the charges Dec. 12.

The Federal Bureau of Investigation and United States Postal Service investigated the case. Assistant United States Attorney Winston David Holliday, Jr., of the Columbia office is prosecuting the case.

Emily Weaver: 843-444-1722, @TSNEmily

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