Missouri testing laboratory co-owner pleads guilty to $3.8 Million in fraudulent billing

Health Care Fraud news graphic
Share To Your Social Network

A former St. Louis County healthcare company owner on Friday admitted submitting more than $3.8 million in fraudulent claims to Medicare, Medicaid, and private healthcare benefit programs. 

Carlos Himpler, 44, now of Baton Rouge, Louisiana, pleaded guilty in U.S. District Court in St. Louis to a felony conspiracy charge.

Himpler, who at the time lived in St. Louis County, described himself as a “business development strategist” and owned or operated a series of healthcare-related businesses. Himpler’s co-defendant, Dr. Franco Sicuro, also owned businesses including Advanced Geriatric Management LLC (AGM) at 10199 Woodfield Lane in Creve Coeur. In the fall of 2014, Himpler and Dr. Sicuro decided to open an in-house testing lab at AGM. They also decided to open Genotec DX, which they held out as a clinical testing laboratory and agreed to split profits 50-50. Genotec was in the same building and used the same testing machine as AGM’s lab.

Their goal was to maximize their profits from the lab testing business. Himpler and Dr. Sicuro sought accreditation for both labs under the Clinical Laboratory Improvement Amendments (CLIA), which set forth quality standards for laboratories that test blood, body fluid, and tissue taken from humans for diagnosis, prevention or treatment of disease. The pair did not disclose that both labs would employ the same part-time employee who would perform tests using the same machine, Himpler admitted in his plea. To convince CLIA to grant Genotec a final certificate of compliance in November 2015, Himpler participated in causing Genotec to make misrepresentations to CLIA, including that Genotec’s testing hours “changed” so that they no longer overlapped with AGM, Genotec and AGM kept separate laboratory logs and AGM stopped lab running samples and transferred its employees to Genotec in July of 2015, when Genotec began running urine toxicology tests, the plea says.

They also concealed Sicuro’s co-ownership of Genotec from Medicare, Medicaid, and private healthcare insurers, while referring urine specimens from Sicuro’s own practice, AGM, to Genotec.

Himpler and Sicuro and other health care providers at AGM ordered urine toxicology tests for patients and referred those tests to AGM’s lab and Genotec, which in turn sent the samples to outside “reference” laboratories. Both men knew AGM and Genotec did not have the necessary testing equipment to confirm the amount of the given toxin in the urine testing to a high degree of certainty, Himpler’s plea says. They then billed health insurers for the testing, despite knowing that Medicare, Medicaid, and many private insurers bar “pass-through billing,” or billing for tests performed by others. 

In March of 2015, Himpler and Sicuro incorporated another laboratory company, Midwest Toxicology Group LLC, but never obtained a CLIA certification or any lab equipment. Midwest was a lab in name only and was not authorized to perform tests on human specimens. When health insurers began scrutinizing claims submitted by Genotec and became resistant to paying them, Himpler and Sicuro created Midwest for the purpose of billing health insurers, the plea says. In many instances, each lab submitted a claim for the testing of the same specimen obtained from the same person on the same day of service, which is known as “split-billing.” The pair used Genotec’s CLIA number.

Himpler admitted in his plea agreement that Medicare, Medicaid, and private healthcare insurers paid $1.4 million in pass-through billing and $2.4 million in split billing. 

“Today’s announcement of an additional guilty plea in this investigation demonstrates that HHS-OIG will continue to hold individuals who exploit federal health care programs accountable,” said Curt L. Muller, Acting Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General. “Health care providers have a responsibility to submit accurate and honest claims to federal health care programs, to ensure that these resources are available for eligible patients.”

Himpler is scheduled to be sentenced on May 15. The conspiracy charge is punishable by up to five years in prison, a fine of up to $250,000, or both prison and a fine. 

Dr. Sicuro pleaded guilty in November 2022 and was ordered to pay restitution. He also agreed to forfeit $3.1 million in assets.

The FBI, the U.S. Department of Health and Human Services Office of Inspector General, and the IRS investigated the case.  Assistant U.S. Attorneys Amy Sestric and Kyle Bateman are prosecuting the case.  

Share To Your Social Network