Psychiatrist Howard Goldstein admitted lying to FBI in Medicaid fraud investigation

October 19, 2010

St. Louis psychiatrist Howard Goldstein pleaded guilty Tuesday and admitted to lying to an FBI agent about making false Medicare billings.

Missouri Attorney General Chris Koster said Goldstein engaged in “upcoding,” a scam whereby he would bill Medicaid for more work than he actually performed. Goldstein, for example, would spend five minutes or less with a patient and then bill Medicaid for a 20-minute session, Koster said.

Goldstein also agreed to pay $830,329 to the United States in a related civil settlement agreement and be excluded from participation in the Medicare program for a period of five years.

In a separate civil settlement agreement, Goldstein’s former employer, SSM St. Charles Clinic Medical Group Inc. and SSM Healthcare Corp. agreed to reimburse the United States an additional $865,812 for Goldstein’s false charges to Medicare, bringing the total civil recovery from the investigation to nearly $1.7 million. 

Missouri will receive $176,748 of the $441,870 Medicaid portion of the settlements as its share based on the federal and state joint funding of the Medicaid program, Koster said. 

The federal felony charge of making a false statement to an agent of the Federal Bureau of Investigation stemmed from an April 2010 interview in which Goldstein minimized and mischaracterized concerns and problems that had been raised by SSM. 

In his plea agreement, Goldstein admitted that between January and June of 2007, the hospital audited his Medicare claims, finding that the medical records created to document the services that Goldstein had billed to Medicare were scant and illegible, raising serious problems, the U.S. attorney’s office said. SSM considered firing Goldstein but decided to allow him to remain employed while requiring attendance at a Medicare coding education session, prosecutors said. 

But later, in March 2009, a peer physician review of Goldstein’s billings revealed more problems, prompting SSM to contact the government and the FBI to launch an investigation. 

Goldstein, 53, formerly of Clayton, now faces a fine of up to $30,000 and a forfeiture of $100,000 under a plea agreement when he is sentenced Jan. 5, 2011.

Source: "St. Louis psychiatrist admits lying to FBI in Medicare probe," St. Louis Business Journal, October 12, 2010.