Fraud gets physician's assistant 20 months in prison
By Nathan Hardin
A physician’s assistant at Cannon Family Medicine in Kannapolis was sentenced Thursday to 20 months in prison for health care fraud in U.S. District Court in Greensboro.
After eight hours of discussion, Federal Judge William L. Osteen concluded that because Christopher John Caggiano served in the military, had extensive community involvement and hadn’t been living a luxurious lifestyle with his fraudulent earnings, he would give slightly less than the recommended sentence of 27-33 months.
Caggiano will however have to pay restitution fees of just under $376,000, as well as a $10,000 fine.
Caggiano, a father of six, owned 99 percent of Cannon Family Medicine when he was charged with four counts of health care fraud. Caggiano pleaded guilty in October of 2008 to all four counts.
“The medical records produced by Mr. Caggiano consistently failed to document or demonstrate detailed medical histories and physical examinations sufficient or adequate for the extensive laboratory and diagnostic testing ordered for each patient,” read the finding released in July 2006 by the N.C. Medical Board.
Caggiano was accused of charging insurance companies for two allergy tests, when only one was administered, or using 36 units and billing the insurance companies for 72 units.
Christie Farmer, a former employee of Caggi-ano’s, administered allergy tests over a five-month period at Cannon Family Medicine. She was supposed to perform two allergy tests on patients, which insurance companies were being billed for. When she asked Caggiano about doing the second test, he told her to skip it.
“Do not do it, period,” Farmer said in court, when asked to repeat what Caggiano had instructed her to do.
She said she thought Caggiano got off lightly.
“I think Caggiano should have gotten a longer sentence, but I don’t think his family should have to pay for his mistakes,” said Farmer.
Other aspects of fraud the defense camp had to deal with were the “unnecessary tests” Caggiano was accused of ordering and the billing of patients’ insurance companies for tests not performed.
“No patients who were uninsured were given tests,” said Vanessa Borden, a former Cannon Family Medicine ultrasound technician.
Borden was fired in late July of 2005 for “missing too many days and having a bad attitude,” according to Brian Cromwell, Caggiano’s attorney.
Borden said she missed one day because of a death in the family and spent a week in the hospital with bronchial asthma.
“We can’t have any more negativity in this practice,” Borden said Caggiano and his wife, Natalia, told her. Borden explained that she believed she was fired because she “thought a lot of things were unnecessary.”
Borden was fired shortly after the medical biller for Cannon Family Medicine lost her job.
The defense tried to portray Borden as a disgruntled former employee because she waited until being fired to call the medical board.
The defense continued its assault on the prosecution’s case by placing Stephanie Robinson, an employee for almost three years, on the stand. Ultimately, however, Judge Osteen found “she did not prove to be persuasive on whether echocardiographs and ultrasounds were being read and reviewed, as is required.”
“The discs were never sent out for interpretation,” Borden confirmed. “I was there from 9 to 5, Monday through Friday.”
The discs and preliminary reports required review and interpretation before a final written interpretation could be given to the insurance companies.
Being the director of the lab allowed Caggiano to “order the test, do the test and review the test,” Judge Osteen said.
One of the biggest arguments the defense fought was that Caggiano “abused a position of trust.”
“Because Christopher Caggiano controlled the day- to-day operations of the practice and promoted and participated in fraudulent billing, the ‘abusive position of trust’ should be applied,” Judge Osteen explained.
“I cannot adequately express how sorry I am,” Caggiano said in his final remarks.
Caggiano also apologized to insurance agencies, his wife and his children for the futures they will have to temporarily endure without him.
“Christopher Caggiano simply tried to cut corners in his business,” Cromwell, Caggiano’s attorney, said. “He wanted to build a better clinic for the community. That’s why he paid his staff well and that’s why he tried to hire the best employees.”
The U.S. District Court will finalize proceedings involving Caggiano’s repayment plans today.