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WC doctor admits making Medicare claim false statements

Dr. Joseph X. Latella appeared in federal court Tuesday in Cedar Rapids

A Webster City doctor faces possible imprisonment and a substantial fine for false statements he made to the United States Attorney’s Office about Medicare claims that he had billed for his nursing home patients.

Dr. Joseph X. Latella, 76, Webster City, plead guilty in federal court Tuesday in Cedar Rapids. He was convicted of one count of making false statements relating to health care matters, according to information released by the U.S. Attorney’s office of the Northern District of Iowa. At the time of the offense, Latella operated a private practice in Webster City and was Hamilton County coroner and medical director for multiple nursing homes in the area.

Latella retired at the end of May from his private practice.

Latella admitted in a plea agreement that, in June 2018, the U.S. Attorney for the Northern District of Iowa was conducting a civil investigation about concerns that Latella was “upcoding” claims submitted to Medicare and Medicaid and billing for more intensive visits with Webster City nursing home patients than he had actually performed. The investigation indicated that Latella was billing over 93 percent of his nursing home visits to Medicare under the most intensive and expensive claim code.

According to the U.S. attorney’s office, for these claims to be valid, a doctor typically must spend 35 minutes at the patient’s bedside and on the patient’s floor or unit. Medicare paid more than $94 for each of these claims, but would have paid as little as $32 if the least expensive claim code, for routine 10 minute visits, had been billed.

Latella was warned in a letter from a Medicare contractor in July 2016 that his billing patterns were significantly more expensive than other doctors.

Latella submitted sworn written answers to the United States Attorney in July 2018. Officials said he falsely declared that he spent approximately 35 minutes for each of 12 patients’ care at two nursing homes, with respect to certain Medicare claims in 2017 and 2018. On one particular date in October 2017, Latella said he “started visiting the nursing home patients at 7:30 a.m. and completed my visits with each patient at approximately 5:30 p.m.” However, a federal agent had conducted in-person surveillance of Latella on that date, and found the doctor was only at the first nursing home for a total of 47 minutes and did not visit the second nursing home at all on that date. The administrator at the first nursing home estimated that the doctor spent approximately five minutes with each nursing home patient during his visits.

According to the U.S. Attorney, Latella made further false statements about claims in January and February 2018, which the Medicaid Fraud Control Unit discovered through videotaped surveillance.

Latella billed nine claims for services allegedly provided to nine Medicare patients on Feb. 2, 2018, at a nursing home, but surveillance showed that he was only on site for a total of 14 minutes.

In total, Latella admitted that between Jan. 1, 2014 and Nov. 30, 2018, he submitted 1,140 false claims to Medicare, which were not justified and he was paid $107,980.59 by Medicare for those claims. Latella also admitted that he caused Medicaid to make unjustified payments in the total amount of $9,218.73 for claims.

As part of his plea agreement, Latella has agreed to pay back no less than $107.980.59 to Medicare and $9.218.73 to Medicaid.

Latella remains free on bond pending sentencing. He will be sentenced before U.S. District Court Chief Judge Leonard T. Strand after a presentence report is prepared. Latella faces a possible maximum of five years imprisonment, a $250,000 fine and three years of supervised release following any imprisonment.

The case is being prosecuted by Assistant U.S. Attorney Tim Vavricek and was investigated by the Department of Health and Human Services, Office of the Inspector General and the Iowa Medicaid Fraud Control Unit.

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