Carpenter Indictment

A,\FILED IN OPEN COU!?T

APR 24 20ttt

CHARLES R' D{/ir{S' ''lR'CLERK

CJB

UNITED STATES OF AMERICA

v.

LAWRENCE CARPENTERa.k.a., CHIP CARPENTER

DIANTHA MILLER

IN THE UNITED STATES DISTRICT COURTF'OR THE SOUTHERN DISTRICT OF ALABAMA

SOUTHERN DIVISION

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criminat No.t+- COOQ & DSUSAO No.: 11R00037

VIOLATIONS:18 U.S.C. S 134918 U.S.C. $ 134718 U.S.C. S 2

INDICTMENT

THE GRAND JURY CHARGES:

At all times relevant to this Indictment:

1. Defendant DR. LAWRENCE CARPENTER, M.D., was a physician, board

certified in obstetrics and gynecology.

2. Defendant DIANTHA MILLER was a certified registered nurse practitioner

(CRNP). A CRNP can provide some medical services, and is considered a physician extender.

3. CARPENTER and MILLER were co-owners of a dermatology clinic, the Laser

Skin Care Center of Mobile (LSCC). CARPENTER owned a sixty percent share of the practice,

while MILLER owned the remaining forty percent share.

4. During the time period relevant to this Indictment, a significant majority of the

patient services rendered at LSCC were performed by physician extenders, including MILLER,

rather than by CARPENTER.

5. CARPENTER and MILLER each had their own National Provider Identifier

G\fPD. An NPI is a unique billing number used to show who performed a patient service.

6. Once a patient service had been provided, LSCC billed the patient's insurance

provider-in this case, either Blue Cross/Blue Shield of Alabama (BC/BS), Alabama Medicaid, or

Case 1:14-cr-00098-WS Document 1 Filed 04/24/14 of 6

Alabama Medicare. All three are "health care benefit programs" as that term is defined in Title

18, United States Code, Section 24(b).

7. BC/BS requires claims to be billed under the name and NPI of the person who

actually rendered the service. In addition, the billing guidelines specifically state, "LJnder no

circumstances should services performed solely by a [physician extender] be billed under a

physician's name and NPI. However, a physician may bill for these services under hislher name

and NPI if the physician also sees and renders services to the patient, reviews the notes of the

physician extender, and concurs with the findings." These guidelines are in place, because

BC/BS reimburses at a higher rate for services provided by a physician than for services provided

by a physician extender.

8. In addition, in most circumstances, both Alabama Medicare and Alabama Medicaid

require that a claim be billed under the name and NPI of the person who actually rendered the

service. With limited exceptions, services performed by a physician extender are only

reimbursed at lower rate than those services performed by a physician.

9. Whether a certain patient service is reimbursed, and if so, for what amount, is

dependent on the billing code included on the claim submitted to BC/BS, Alabama Medicaid,

Alabama Medicare.

COUNT ONE

10. Beginning in or about January 2007 and continuing through in or about December

2011, in the Southern District of Alabama, Southern Division, the defendants,

LAWRENCE CARPENTER, a.k a., CHIP CARPENTER, andDIANTHA MILLER

did willfully, knowingly, and unlawfully combine, conspire, confederate, and agree with each

other and others, both known and unknown to the grand jury, to commit certain offenses against

the United States. to wit:


to knowingly and willfully execute, and attempt to execute, a scheme and artifice todefraud a healthcare benefit program, and to obtain, by means of false andfraudulent pretenses, representations, and promises, money and property owned by,and under the custody and control of, a healthcare benefit program in connectionwith the delivery of and payment for healthcare benefits, items, and services, inviolation of Title 18, United States Code, Section 1347(a).

Obiectives of the Conspiracv

11. The objectives of the conspiracy were to unlawfully increase the amount of

reimbursement LSCC received from healthcare benefit programs by:

(1) Fraudulently billing under a physician's NPI when a patient had been treated by a

physician's extender rather than a physician, and

(2) Fraudulently altering billing codes when a reimbursement had been denied, and then

resubmitting the altered bill for reimbursement.

' Manner and Means

12. The manner and means used to achieve these objectives included, but were not

limited to, the following:

A. Patient services performed by MILLER or other LSCC physician

extenders were fraudulently billed to various healthcare benefits programs under

CARPENTER's NPI. Both CARPENTER and MILLER knew billing claims

falsely bearing CARPENTER's NPI were being submitted to patients' insurance

providers.

B. MILLER directed others at LSCC to change billing codes if

reimbursement was initially denied by a healthcare benefits program. The billing

claims bearing the falsified codes were then re-submitted for reimbursement.

Both CARPENTER and MILLER knew this practice was occurring.

All in violation of Title 18, United States Code, Section 1349.


COUNT TWO

13. Beginning in or about January 2007 and continuing through in or about December

2011, in the Southern District of Alabama, Southern Division, the defendants,

LAWRENCE CARPENTER, a.ka., CHIP CARPENTER, andDIANTHA MILLER

aided and abetted by each other and others, both known and unknown to the Grand Jury, did

knowingly and willfully execute, and attempt to execute, a scheme and artifice to defraud a

healthcare benefits program, and obtain by means of false and fraudulent pretenses,

representations, and promises, money and property owned by, and under the custody of, a

healthcare benefit program, in connection with the delivery of and payment for healthcare benefits,

items, and services

14. Specifically, patient services performed by MILLER or other LSCC physician

extenders were fraudulently billed to various healthcare benefits programs under CARPENTER's

NPI. Both CARPENTER and MILLER knew billing claims falsely bearing CARPENTER's

NPI were being submitted to patients' insurance providers.

In violation of Title 18, United States Code, Sections 1347 and2.

COUNT THREE

15. Beginning in or about January 2007 andcontinuing through in or about December

2011, in the Southem District of Alabama, Southem Division, the defendants,

LAWRENCE CARPENTER, a.k a., CHIP CARPENTER, andDIANTHA MILLER

aided and abetted by each other and others, both known and unknown to the Grand Jury, did

knowingly and willfully execute, and attempt to execute, a scheme and artifice to defraud a

healthcare benefits program, and obtain by means of false and fraudulent pretenses,

representations, and promises, money and property owned by, and under the custody of; a

healthcare benefit program, in connection with the delivery of and payment for healthcare benefits,

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items, and services

16. Specifically, MILLER directed others at LSCC to change billing codes if

reimbursement was initially denied by a healthcare benefits program. The billing claims bearing

the falsified codes were then re-submitted for reimbursement. Both CARPENTER and

MILLER knew this practice was occurring.

In violation of Title 18, United States Code, Sections 1347 and2.

FORFEITURE NOTICE

The allegations contained herein are hereby realleged and incorporated by reference for the

pu{pose of alleging forfeiture pursuant to Title 18, United States Code, Section 952(a)(7).

Upon conviction for an offense in violation of Title 18, United States Code, Section 1347,

as alleged in Counts Two and Three of the Indictment, LAWRENCE "CHIP" CARPENTER

and DIANTHA MILLER shall forfeit to the United States, pursuant to Title 18, United States

Code, Section 982(a)(7), any property, real or personal, that constitutes or is derived, directly or

indirectly, from gross proceeds traceable to the commission of the offense.

If the property described above, as a result of an act or omission by the defendant:

a. cannot be located upon the exercise ofdue diligence;

b. has been transferred or sold to, or deposited with, a third party;

c. has been placed beyond the jurisdiction of the court;

d. has been substantially diminished in value; or

e. has been commingled with other properfy which cannot be divided without

difficulty;

the United States shall be entitled to forfeiture of substitute property pursuant to Title 21, United

States Code, Section 853(p), as incorporated by Title 18, United States Code, Section 982(bX1)

and Title 28, United States Code, Section 2461(c).


A TRUE BILL

REMAN. UNITED STATES GRANSOUTHERN DISTRICT OF ALABAMA

KENYEN R. BROWNLINITED STATES ATTORNEY

Chief, Criminal Divrsron

APRIL 2014

G. ChenyAssistant U.S. A

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0PENALTY PAGE

CASE STYLE: UNITED STATES v. CARPENTER. et. aI

DEFENDANTS: LAWRENCE CARPENTERDIANTHA MILLER

USAO NUMBER: 11R00037

AUSA: CHRISTOPHER J. BODNAR

COUNT 1: 18 U.S.C. S 1349 - Conspiracy to Commit Heatthcare Fraud

COUNTS 2-3: 18 U.S.C. $ 1347, 2 - Health Care X'raud & Aiding and Abetting

PENALTY:Count 1: 10 yrs/$250,000/3yrs SRT/$100 SA

Counts 2-3: 10 yrs/$250,000/3yrs SRT/$100 SA

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Case 1:14-cr-00098-WS Document 1-1 Filed 04/24/14 Page 1 of 1

Carpenter Indictment

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