Cambria County Plastic Surgeon Pleads Guilty to $288K in Medicaid and Insurance Fraud

May 25, 2018 | Topic: Criminal

Attorney General Josh Shapiro Announces Sentence against Doctor who Faked Billings for Higher Reimbursements

HARRISBURG – Attorney General Josh Shapiro announced that a Johnstown plastic surgeon who routinely billed Medicaid and private insurers for cancer treatments – even when the growths were not cancerous – pleaded guilty today to two felonies. The surgeon bilked private insurers and the Medicaid program out of $288,974 through this continuing scheme.

Dr. Daniel R. Nevarre, 58, pleaded guilty today to Medicaid fraud and insurance fraud, both third-degree felonies. He waived his preliminary hearing and was sentenced by President Judge Norman Krumenacker today in Cambria County to six to 23 months of house arrest, followed by three years of probation. Nevarre was the owner and operator of Plastic Surgical Associates of Johnstown, which he sold in May 2017.

“When people commit Medicaid fraud, they’re stealing tax dollars from people who are in real need of health care services,” Attorney General Josh Shapiro said. “Insurance fraud is also a serious crime that drives up premiums for everyday Pennsylvanians.  This plastic surgeon gamed the system for his own profit – I won’t tolerate that, and we will hold him accountable.”

Starting in 2010, employees of Plastic Surgical Associates of Johnstown noticed Nevarre was billing all tissue samples as cancerous — even when subsequent laboratory reports indicated the tissues were non-cancerous. Nevarre also regularly up-coded routine procedures near the eye area as complex eyelid reconstructions — a surgery that requires at least a quarter of the eyelid to be reconstructed. Both of these fraudulent schemes resulted in higher reimbursements to Nevarre and his practice.

The defrauded insurance providers include Highmark Blue Cross/Blue Shield, UPMC, Medicare and the Pennsylvania Medical Assistance (Medicaid) program. Nevarre was ordered to pay full restitution to these providers as a condition of his sentence.

The case was prosecuted by Senior Deputy Attorney General Kara Cotter and Deputy Attorney General Edward Song.

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