Psychiatrist Joseph Spare will repay $150,000 in improper insurance billings

May 11, 2013

MARION — A Marion psychiatrist agreed to repay the Ohio Bureau of Workers’ Compensation for improperly billing the agency for more than 1,100 psychotherapy sessions conducted by underqualified staff members, a BWC news release states.

Dr. Joseph Spare and the Marion Independent Physicians Association, of which Spare is a member, agreed to repay BWC $150,000 to cover the overpayment and investigative costs.

“Dr. Spare billed the BWC for a much higher number of services than his peers, and we took notice of that,” Steve Buehrer, BWC administrator/chief executive officer, said, according to the news release. “When people think of workers’ compensation fraud, they often picture injured workers. However, workers’ compensation fraud can and does include employers and providers. We’re committed to bringing anyone who commits fraudulent activity to justice.”

The BWC’s intelligence unit detected that Spare was billing for a large number of counseling and medication management sessions. BWC received bills indicating Spare performed both services for each session, but the special investigations department’s health care provider fraud team found the counseling sessions were being performed by three of his staff members, MIPA employees who weren’t licensed to provide counseling. Spare was only checking the patients’ medication at the end of their counseling sessions.

The three underqualified MIPA personnel conducted more than 1,100 psychotherapy sessions between January 2004 and August 2007. As a result of using these improperly licensed staff to perform counseling services, Spare’s office was able to see more patients per day, generating more revenue than it was entitled to receive.

In response to phone messages left for Spare, his attorney, James L. Ervin Jr., sent the following email he said was a joint response by Spare and MIPA to The Marion Star: “Dr. Joseph T. Spare and the Marion Independent Physicians Association (‘MIPA’) have been and remain committed to providing the best healthcare, including mental health services, to the people of Marion, and the greater Central Ohio community. While a lawsuit was filed, Dr. Spare and MIPA have always denied any of the alleged wrongdoing. Dr. Spare and MIPA entered into an amicable settlement for a number of reasons, including the costs of litigation, avoiding a long protracted legal battle, and wanting to turn their full attention to providing quality healthcare as soon as possible. Although a settlement was reached, neither Dr. Spare nor MIPA admitted to any wrongdoing, fraud, misconduct, or liability regarding any of the claims or allegations made in the lawsuit. Dr. Spare and MIPA will continue to focus on providing the best healthcare to the Marion community in a manner that focuses on the highest quality of patient care in full compliance with all applicable rules, regulations, and laws.”

Originally, the attorney general’s office sought $89,286 in repayment, said Dan Tierney, a spokesman for the office.

Tierney said the attorney general’s office pursued the matter as a civil lawsuit, in part, because the standard of proof fit a civil case better than a criminal prosecution.

A civil case requires a standard of proof of a “preponderance of evidence” while a criminal case requires proof “beyond a reasonable doubt,” he said, adding a criminal case also would require the state “to prove an intent to defraud, which means the defendant knew he was not entitled to bill the state, so based upon the evidence obtained in investigating, our investigators felt it more appropriate to pursue civil charges than criminal charges.”

The BWC will refer information about the matter to the state medical board, said Melissa Vince, a spokeswoman for the agency.

Joan Wehrle, state medical board spokeswoman, said the board has no record of disciplinary action being taken against Spare.

“We will try to get the copies of the information regarding the BWC action and try to get the information about the BWC action, then the board would have to review it to determine whether or not it would qualify for an action against his license by the medical board,” Wehrle said.

Source: John Jarvis, "Psychiatrist will repay $150K to Ohio BWC," The Marion Star, May 8, 2013.