State alleges $9 million Medicaid fraud in lab-testing-for-profit scheme
December 26, 2019
(Anchorage, AK) –The State of Alaska filed criminal charges against Dr. John Zipperer, Jr. MD and his corporation for an alleged fraud against the state Medicaid program. The State alleges that Dr. Zipperer defrauded the state Medicaid program by filing millions of dollars worth of claims for fraudulent laboratory urine tests performed from August of 2013 to August of 2015. The State alleges that Dr. Zipperer defrauded the Alaska Medicaid program by performing over one million medically unnecessary laboratory tests on patients’ biological samples at a Tennessee lab he personally owned and then billing Medicaid for those medically unnecessary tests.
The State alleges that Dr. Zipperer opened a clinic in Wasilla in 2012. Shortly thereafter, he expanded across the State. In August of 2013, Dr. Zipperer opened his own laboratory testing facility in Franklin, Tennessee. He would see his Alaska patients as often as once every three days. Often times, at each of those visits he would require his patients to submit urine samples for testing. Dr. Zipperer would then send the urine samples to his Tennessee lab, and order comprehensive and repetitive tests—frequently in cases where preliminary testing showed negative results. Dr. Zipperer would order dozens of unnecessary and duplicative tests on each urine sample and then bill Medicaid, private insurance companies, or cash-paying patients personally, at rates ranging from $3,000-$8,000 per urine sample.
The State alleges that between August 2013 through September 2015, Dr. Zipperer was reimbursed about $9 million for laboratory testing—an amount over ten times greater than the combined total of all other providers in the Alaska Medicaid system for laboratory test codes billed during that time period.
In 2018, the case triggered a formal state audit review. As a condition of Medicaid enrollment, providers are legally obligated to cooperate with agency audits and are required to provide supporting documentation to the state Medicaid program when requested. The State alleges that throughout 2019, Dr. 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. This refusal itself is a criminal offense under Alaska law. The State has formally charged this offense as well.
A more detailed summary of the case is included in the charging document filed in state court. The charging document may be found on the State of Alaska, Medicaid Fraud Control Unit website, here: http://law.alaska.gov/department/criminal/mfcu.html.
The charges of medical assistance fraud against Dr. Zipperer carry a possible sentence of up to 10 years in prison, a fine of up to $100,000 and restitution to the State of Alaska Medicaid program. The charges of medical assistance fraud against the corporation carry a possible maximum sentence of up to $5 million, and a potential restitution order. A conviction can lead to exclusion from the Alaska Medicaid program.
Any person who may have information about Dr. Zipperer or facts related to this case are encouraged to contact the State of Alaska, Medicaid Fraud Control Unit at (907) 269-6279.
All of the charges discussed herein are merely allegations and do not constitute evidence of guilt. All defendants are presumed innocent. All defendants are entitled to a trial at which the government must prove guilt beyond a reasonable doubt.
CONTACT: Director of the Medicaid Fraud Control Unit James Fayette at firstname.lastname@example.org or (907) 269-6279.
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Department Media Contact: Senior Assistant Attorney General Cori Mills at (907) 465-2132 or email@example.com.