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Alaska doctor charged with Medicaid fraud over lab tests

December 26, 2019 GMT

A physician who Alaska prosecutors say filed millions of dollars in false claims for laboratory tests has been charged with felony and misdemeanor counts of medical assistance fraud.

Dr. John Zipperer Jr. defrauded the Alaska Medicaid program by performing more than 1 million unnecessary lab tests on patients’ urine samples at a lab he owned in Tennessee, prosecutors said in an announcement Thursday.

Zipperer was reimbursed nearly $9 million for lab testing from August 2013 through August 2015, prosecutors said. That was more than 10 times the amount for laboratory test codes billed by all other providers in the Alaska Medicaid system, prosecutors said.

Zipperer no longer practices in Alaska, prosecutors said in the criminal complaint. Online court documents do not list an attorney who could comment on the case and a message left on Zipperer’s Alaska phone number was not immediately returned.

Zipperer opened a clinic in Wasilla in 2012, prosecutors said, and expanded to other locations.

In August 2013, he opened a laboratory testing facility in Franklin, Tennessee.

According to prosecutors, he would see Alaska patients as often as once every three days and often would require urine tests that he would send to the Tennessee lab. Zipperer would order comprehensive and repetitive tests, frequently on samples where preliminary testing showed negative results, prosecutors said.

Zipperer billed Medicaid, private insurance companies and patients paying cash for dozens of duplicative tests at $3,000 to $8,000 per urine sample, prosecutors said.

Alaska initiated a formal state audit review in 2018. Medicaid providers are legally obligated to cooperate with agency audits and are required to provide supporting documentation when requested, prosecutors said. Zipperer failed to respond to repeated requests for supporting documentation for the millions of dollars worth of claims he submitted in response to agency requests, prosecutors said, noting the refusal itself if is a criminal act.

The medical assistance fraud charges filed carry a maximum sentence of 10 years in prison and a fine of up to $100,000 plus restitution, prosecutors said. Zipperer’s corporation is also charged.