Utah Podiatrist and Two Nurses Charged in $29 Million Medicare Fraud Scheme

ST. GEORGE, Utah — A federal grand jury returned an indictment May 12 charging Utah podiatrist and two nurses who worked for him with health care fraud after they submitted false claims to Medicare for skin substitute services, many of which were medically unnecessary.

The indictment names the three defendants and alleges they caused Medicare to pay $29 million on the fraudulent claims. Per the U.S. Department of Justice announcement, the charges were brought in the U.S. District Court for the District of Utah.

The scope of the alleged scheme centers on Medicare, the federal health insurance program that covers more than 65 million elderly and disabled Americans. The defendants are accused of billing for skin substitute procedures that were not medically necessary, a category of service used to treat chronic wounds but subject to strict documentation and medical-necessity requirements under Medicare rules.

The indictment shifts the matter from allegation to formal criminal charges under federal health care fraud statutes. The defendants now face arraignment and potential trial in federal court; if convicted they face statutory penalties that include restitution of the $29 million in Medicare payouts plus fines and prison terms.

Downstream, the case requires the Department of Justice to prosecute the indictment and the Centers for Medicare & Medicaid Services to review any ongoing claims or provider enrollments tied to the defendants. Conviction would automatically trigger exclusion from federal health care programs under the Social Security Act, barring the defendants from billing Medicare or Medicaid.

The U.S. Attorney’s Office for the District of Utah must next present evidence at trial or negotiate resolutions that could include guilty pleas and repayment agreements.

This indictment forms part of the Justice Department’s ongoing enforcement against health care fraud schemes involving high-cost skin substitute products. The department has brought similar cases in multiple districts in recent years after audits revealed widespread billing for medically unnecessary applications of these products, which can cost thousands of dollars per treatment.