A former healthcare company owner from St. Louis County was sentenced to 20 months (1 year, 8 months) in prison and fined $100,000 for submitting more than $3.8 million in fraudulent claims to Medicare, Medicaid, and private healthcare benefit programs. The sentence was handed down by U.S. District Judge Sarah E. Pitlyk on Tuesday.
Carlos Himpler, 44, owned and operated several healthcare-related businesses. One of his ventures included Advanced Geriatric Management LLC (AGM), co-owned by Dr. Franco Sicuro. In the fall of 2014, the two men decided to open an in-house testing lab at AGM, which led to the establishment of Genotec DX, a clinical testing laboratory in the same building using the same equipment as AGM’s lab.
Himpler and Dr. Sicuro sought accreditation for both labs under the Clinical Laboratory Improvement Amendments (CLIA), which regulate quality standards for laboratories. However, they failed to disclose that both labs would employ the same part-time employee to conduct tests using the same machine. To secure Genotec’s final certificate of compliance in November 2015, Himpler was involved in misleading CLIA, including falsifying claims that Genotec’s testing hours had been altered to avoid overlapping with AGM. Additionally, they misrepresented that AGM had stopped running samples and transferred employees to Genotec in July 2015, when, in fact, the AGM lab continued operations, and Genotec had started testing before July 2015.
The pair also concealed Dr. Sicuro’s co-ownership of Genotec from Medicare, Medicaid, and private healthcare insurers, while referring urine specimens from Sicuro’s practice at AGM to Genotec. Himpler and Dr. Sicuro, along with other AGM health care providers, ordered urine toxicology tests for patients and referred those tests to AGM’s lab and Genotec, which subsequently sent the samples to external reference laboratories.
Himpler’s plea agreement revealed that AGM and Genotec lacked the necessary equipment to confirm toxin levels in urine tests with high certainty. Despite this, they billed health insurers for the tests, even though Medicare, Medicaid, and many private insurers prohibit pass-through billing, where charges are made for tests performed by others.
As insurers became hesitant to pay Genotec’s claims, Himpler and Dr. Sicuro created another laboratory company in March 2015, Midwest Toxicology Group LLC, to bill health insurers. However, Midwest was a lab in name only, lacking both CLIA certification and lab equipment. Himpler admitted that they submitted fraudulent claims, often using Genotec’s CLIA number under Midwest’s name.
Himpler’s plea agreement disclosed that Medicare, Medicaid, and private insurers paid $1.4 million in pass-through billing and $2.4 million in split billing.
Dr. Sicuro pleaded guilty in November 2022, satisfied the restitution owed, and agreed to forfeit $3.1 million in assets.
The case was investigated by the FBI and the U.S. Department of Health and Human Services Office of Inspector General. Assistant U.S. Attorneys Dorothy McMurtry, Amy Sestric, and Kyle Bateman prosecuted the case.
