JACKSONVILLE, Fla. – A 55-year-old Ocala doctor pleaded guilty Monday to one count of health care fraud in a case that involved clipping toenails, according to the U.S. Attorney's Office.
Michael Rotstein faces a maximum penalty of 10 years’ imprisonment and must pay mandatory restitution of approximately $1.5 million. A sentencing date has not yet been set.
According to the plea agreement, Rotstein, a podiatrist, billed the Medicare and TRICARE health care programs and was one of the highest billers in the country for a medical service requiring the “removal of skin and muscle.”
He claimed that nearly half of his procedures were for the removal of skin and muscle, placing him in the top one-percent of billers nationwide for this procedure, but he did not actually perform these procedures, prosecutors said.
Rather, the majority of the times that he billed for these procedures, he was actually performing routine foot care, including the clipping of toenails, which is not a reimbursable service under Medicare or TRICARE, authorities said.
Since the services performed were not reimbursable, Rotstein devised a scheme to submit claims to the Medicare and TRICARE programs that included using a false diagnosis code and false billing code.
He also included notes in his patients’ medical files to make it appear that he was actually performing these services.
As a result of the scheme, Rotstein received $1,504,952.67 in health care reimbursements to which he was not entitled.
The case was investigated by the Department of Health and Human Services, Office of Inspector General.