A federal grand jury returned an indictment on May 12, 2026, charging a Utah podiatrist and two nurses who worked for him with fraud after they allegedly submitted fraudulent claims to Medicare for skin substitute services, many of which were medically unnecessary, resulting in Medicare paying approximately $29 million in claims.
According to allegations in court documents, from July 2021 through December 2025, the defendants allegedly defrauded Medicare to obtain money for their own financial benefit.
The podiatrist owned and operated clinics throughout Utah. The nurses, a licensed nurse practitioner and a licensed registered nurse, worked primarily out of the podiatrist’s St. George clinic.
According to the indictment, the defendants knew Medicare billing for skin substitute services was permissible only when medically necessary and when basic wound care had been administered for at least 30 days. However, they allegedly submitted false claims to Medicare for patients who did not have qualifying wounds or for whom continued skin substitute treatment was medically unnecessary.
As part of the alleged scheme, the defendants routinely failed to pursue Medicare copayments from beneficiaries for skin substitute services, even when beneficiaries would have owed thousands of dollars. The podiatrist also allegedly directed unqualified medical personnel, including the registered nurse, to provide skin substitute services outside the nurse’s professional scope of practice. He then allegedly submitted claims to Medicare for those services under his own provider number.
According to the indictment, the podiatrist billed Medicare approximately $44 million for skin substitute services, many of which were allegedly unnecessary, and Medicare paid more than $19 million on those claims. The nurse practitioner allegedly billed approximately $17 million for similar services, and Medicare paid more than $10 million on those claims.
The three defendants are charged with healthcare fraud and wire fraud. The podiatrist and registered nurse are also charged with false statements relating to healthcare matters.
Compliance Perspective
Issue
Healthcare providers participating in Medicare and other federally funded programs are required to ensure that all services billed for reimbursement are medically necessary, accurately documented, and performed by appropriately licensed and qualified individuals acting within their scope of practice. Billing for services that are not medically necessary, not supported by documentation, or performed by unqualified personnel may result in civil and criminal liability, exclusion from federal healthcare programs, and other regulatory sanctions.
Discussion Points
- Review and update policies and procedures related to documentation standards, billing compliance, scope of practice requirements, supervision of clinical services, and staff licensure and competency verification. Policies should clearly define allowable services by licensure level, supervision expectations for clinical tasks, and expectations for accurate and complete documentation supporting medical necessity. Policies should also include procedures for identifying and reporting potential compliance concerns. Facilities may benefit from periodic policy review in collaboration with regulatory compliance partners or external consultants to help ensure alignment with current federal and state requirements.
- Provide ongoing education and training to appropriate staff on documentation accuracy, medical necessity requirements, scope of practice limitations, licensure requirements, and federal and state billing regulations. Training should reinforce that services must be properly documented, appropriately billed, and performed by qualified and supervised personnel, and that staff are responsible for reporting compliance concerns through established channels. Med-Net Academy offers the course Fraud Module 16 – Financial Integrity, which focuses on accurate and compliant reimbursement claims supported by verifiable documentation, as well as The Importance of Proper Licensure – A Case Study, which examines licensure requirements, scope-of-practice adherence, and compliance failures.
- Conduct routine and targeted audits to ensure billed services are supported by contemporaneous documentation and performed by appropriately licensed and supervised personnel. Audits should include review of claims data, clinical documentation, and verification of staff credentials, licensure, and supervision records. Independent or third-party reviews, including structured compliance assessments and mock survey methodologies, may assist in identifying risk areas, strengthening internal controls, and supporting timely corrective action. Contact Med-Net Healthcare Consulting or info@mednetconcepts.com for more information.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*