Dr. Joseph X. Latella, 76 of Webster City, was sentenced on Thursday to two months in federal prison and fined after previously pleading guilty to making false statements related to health care matters.

As part of the plea agreement, Latella also agreed to pay $316,438.96 to resolve False Claims Act allegations related to claims he submitted for routine visits for nursing facility residents between Jan. 1, 2014 and Nov. 30, 2018.

The United States alleged that Latella, a long-time primary care doctor in Webster City, submitted claims to Medicare and Medicaid for the most intensive and expensive claim code for such visits when, in fact, he was not performing services sufficient to justify use of that code.

“Like all providers, doctors who treat Iowa’s elderly population have a duty to provide needed medical services and bill accurately for those services.  By his alleged actions, Dr. Latella scammed the healthcare system and left his elderly patients and their families wondering if the patients received care they needed,” said Peter E. Deegan Jr., United States Attorney for the Northern District of Iowa.  “When our office’s civil investigators made an official inquiry into his billing practices, Dr. Latella tried to throw the government off the scent by lying and creating false records.  This settlement and prosecution demonstrate my office’s focus on ensuring Medicare and Medicaid beneficiaries receive the care to which they are entitled, public monies are well spent, and individuals or entities responding to my office’s civil investigative demands provide complete and truthful responses.”

A 2018 investigation by the United States Attorney for the Northern District of Iowa found that Latella was billing more than 93 percent of his nursing home visits to Medicare under the most intensive and expensive claim code.

For those claims to be valid, a doctor typically must spend 35 minutes at the patient’s bedside and on the patient’s facility floor or unit. Medicare paid more than $94 for those claims, but would have paid no more than $32 if the least expensive claim code, for routine 10-minute visits, had been billed.

In July 2016, a Medicare contractor sent Latella a letter warning him that his billing patterns were significantly more expensive than other doctors.

In July 2018, Latella submitted sworn written answers to the U.S. Attorney, in which he falsely declared that, with respect to certain Medicare claims in 2017 and 2018, he had spent approximately 35 minutes for each of 12 patients’ care at two nursing homes.

About one particular date in October 2017, Latella falsely swore 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 Latella was only on site 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 of the first nursing home estimated that Latella spent approximately five minutes with each patient during his visits to that nursing home.

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 Latella was only on site at the nursing home for a total of 14 minutes.

In order to cover up his overbilling scheme, Latella provided the United States Attorney with fraudulent, re-created treatment notes. The U.S. Attorney said Latella’s staff had a practice of shredding all notes for all nursing home patients immediately after billing Medicare and Medicaid for those services. At the time of the audit, Latella had no records of any treatment he had ever provided to patients at nursing homes.

To re-create the notes, Latella contacted the nursing home administrators and nursing managers of various nursing homes and asked for copies of patients’ charts.

Latella was the medical director of two nursing homes at which he was billing fraudulently. He was also the Hamilton County Coroner, provided services to inmates in the Hamilton County Jail and in the custody of the United States Marshal’s Service and evaluated workers’ compensation claims for a major Webster City employer.

Latella also operated a private medical practice in Webster City for many years before closing the practice in May 2019.

In total, Latella admitted that between Jan. 1, 2014, and Nov. 30, 2018, he submitted 1,140 false claims to Medicare and was paid $107,980.59 for those claims. He also received unjustified payments totaling $9,218.73 from Medicaid for those claims.

As part of his plea agreement, Latella has agreed to repay those payments to Medicare and Medicaid.

“Government health care rules require bills be submitted only for services actually provided – anything more is fraudulent and a disservice to patients needing vital care,” said Curt L. Muller, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “We will continue to protect the integrity of government health care programs and taxpayers funding these vital services by holding providers fully accountable.”

The civil case was handled by Assistant United States Attorneys Melissa Carrington and Jacob Schunk. The criminal case was prosecuted by Assistant United States Attorney Tim Vavricek.

The cases were investigated by the Department of Health and Human Services, Office of the Inspector General and the Iowa Medicaid Fraud Control Unit.