U.S. District Judge Stephen R. Clark sentenced a Moberly, Missouri, doctor to 22 months in prison on Thursday for fraudulently using his father’s name to bill Medicare and Medicaid for medical services.
Justin G. LaMonda was also ordered to repay $537,332.
LaMonda’s crimes began after the Missouri Board of Registration for the Healing Arts suspended his medical license for 30 days in 2017. He was accused of engaging in sexual activity with his office manager and prescribing her controlled substances “without sufficient examination and outside the usual course of professional practice,” according to LaMonda’s plea agreement.
On Dec. 20, 2018, a Medicare administrative contractor revoked LaMonda’s Medicare Part B privileges after determining that he had submitted reimbursement claims for services performed while he was suspended.
LaMonda and his father, who was also a doctor, agreed to bill Medicare for services performed by LaMonda as though they had been performed by his father.
On Sept. 12, 2019, the Missouri Medicaid Audit and Compliance Unit terminated Dr. LaMonda’s provider number. LaMonda and his father then expanded their scheme to include Medicaid claims.
LaMonda instructed his billing personnel to use his father’s unique billing provider number on claims for payment, referrals to other healthcare providers, and orders for durable medical equipment. He falsely claimed that his father had performed the medical services or ordered additional equipment or treatment, according to his plea agreement.
When LaMonda’s father received payments from Medicare and Medicaid for services purportedly performed by him, he transferred the funds to his son.
LaMonda admitted to causing total losses of $537,332 to Medicare and Missouri Medicaid.
LaMonda “flagrantly violated” the revocation of his Medicare and Medicaid billing privileges by fraudulently billing those programs, Assistant U.S. Attorney Amy Sestric wrote in a sentencing memorandum.
“Health care professionals who intentionally submit such blatantly fraudulent information can adversely affect individuals who depend on Medicare and Medicaid for access to safe and effective health care services. The laws are meant to ensure both the integrity of program funds and the provision of appropriate, quality services to patients,” stated Special Agent in Charge Curt L. Muller with the U.S. Department of Health and Human Services Office of Inspector General. “Our agency collaborates frequently with our law enforcement partners to investigate providers who undermine our federal health care programs and the well-being of patients.”
LaMonda, 42, pleaded guilty in March to two counts of making false statements related to health care matters. His medical license has been revoked. LaMonda’s father, Dr. Gary LaMonda, died in September 2021.
The U.S. Department of Health and Human Services Office of Inspector General, the FBI, and Missouri’s Attorney General’s Medicaid Fraud Control Unit investigated this case. Assistant U.S. Attorney Amy Sestric prosecuted the case.
