UPDATE: Addiction clinic operator sentenced in health care fraud case

Eugene Sisco, III, of Pikeville, was sentenced to more than ten years in federal prison

Update from March 8, 2022:

PIKEVILLE, Ky. (WTVQ) – A Pikeville man was sentenced Tuesday to 125-months in federal prison and ordered to pay $5.7 million in restitution in a health care and wire fraud case, according to federal prosecutors.

36-year old Eugene Sisco, III was convicted in November 2021.

He operated several medication assisted treatment (‘MAT’) clinics in Pike, Floyd and Harlan counties that offered treatment to people addicted to opioids.

He deceived patients into paying hundreds of dollars per month in cash for treatment after falsely claiming his clinics weren’t eligible to bill Medicaid for certain services, according to prosecutors.

The evidence at trial showed the cash payments from patients totaled around $5 million between May 2016 and October 2019, most of it from people who had Medicaid who shouldn’t have had to pay anything for the services.  At the same time, Sisco caused his clinics to bill Medicaid for MAT services, receiving millions of dollars in reimbursements from that program.

He defrauded the Medicaid and Medicare programs out of more than $2 million, according to his conviction.

The jury also found Sisco caused his laboratory, Toxperts, LLC, to bill for medically unnecessary urine drug testing of samples collected from patients at his clinics.  Sisco is not a doctor or medical professional.

 

Original story below from November 20, 2020:

PIKEVILLE, Ky. (WTVQ) – A two-year investigation has led to the indictment of a man who owns several rehabilitation facilities in Pike, Floyd and Harlan counties on a health care fraud scheme, according to Kentucky State Police.

Investigators say Eugene Sisco III is accused of illegally charging patients cash for services that are covered by Medicaid and then fraudulently billing Medicaid, dating back to 2016.

KSP says Sisco received more than $3 million in cash paid to him by patients seeking treatment for addiction.

Federal Search Warrants were executed on five of Sisco’s businesses in February of this year, according to investigators.

Sisco was indicted on Federal Wire Fraud charges, which carry a maximum of 20-years in federal prison as well as Health Care Fraud, which carries a maximum of ten-years in federal prison, according to State Police.

This was a joint investigation by Appalachia Narcotics Investigations, Diversion Enforcement Task Force ,the FBI HEAT Task Force (All Appalachia HIDTA Task Forces) and the United States Attorneys Office in Lexington.  They were assisted by the Kentucky State Police, Harlan County Sheriffs Office, Harlan Police Department and the Kentucky Office of the Attorney General Medicaid Fraud Control Unit.

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