Eastern KY man convicted for double-billing patients, feds
A Pikeville man was convicted of health care and wire fraud after a federal jury ruled he made millions of dollars off a double-billing scheme that took money from opioid addiction patients and Medicaid.
Eugene Sisco III made about $10 million by telling medicaid patients they had to pay cash for opioid addiction treatments while also billing medicaid for the services, according to evidence presented at trial. Sisco, 36, was convicted Monday. His trial lasted six days and the jury deliberated for two and a half hours, according to court records.
Sisco, who isn’t a doctor or medical professional, deceived patients and made them pay up to $300 per month in cash to be treated at his clinics, according to the U.S. Department of Justice. He had clinics in Pike, Floyd and Harlan counties. He made about $5 million off those cash payments from May 2016 to October 2019.
Sisco claimed he wasn’t able to bill medicaid for the clinics’ services. But his clinics were enrolled as providers in the Kentucky medicaid program, which meant they were required to bill medicaid for medication assisted treatment provided to medicaid patients, according to prosecutors.
Despite claiming he wasn’t able to bill medicaid and causing patients to pay out-of-pocket, Sisco also billed medicaid. He made about $5 million in reimbursements from medicaid, according to the Department of Justice.
When employees and contractors questioned the legality of the practice, Sisco lied and said the cash payments were for counseling or drug testing that Medicaid wouldn’t cover, according to his indictment. He was indicted in November 2020. Sisco knew the program would reimburse for providing counseling to patients, according to court records.
The clinics involved were called Renew Addiction Treatment Clinic LLC, also known as Behavioral Health Professionals, according to Sisco’s indictment.
Sisco also operated Renew Residential Treatment Services, also known as Brookside, which has a residential treatment facility in Pike County; Alcohol and Substance Abuse Professionals LLC; and ASAP Addiction Treatment LLC, according to the indictment.
Sisco also had his laboratory, Toxperts LLC, bill for “medically unnecessary” urine drug testing of samples collected from patients.
Sisco required patients at his clinics to provide a urine sample for testing every time they showed up, according to the indictment.
“The physician witnesses at trial testified that they did not order this urine drug testing, and that some of it was done at Sisco’s direction for billing purposes, as opposed to any medical reason,” prosecutors said in a news release Tuesday.
Sisco will appear for sentencing in federal court on March 8. He could face up 20 years for wire fraud and up to 10 years for health care fraud. A federal judge will consider U.S. sentencing guidelines before determining Sisco’s sentence.
Jeremy Chisenhall covers breaking news for the Lexington Herald-Leader and Kentucky.com. He joined the paper in 2020, and is originally from Erlanger, Ky.
