Doctor who performed unneeded procedures guilty in $12-million Medicare fraud scheme

The Department of Justice seal.
(Jose Luis Magana / AP)

A federal grand jury found a Southern California doctor guilty of seven counts of healthcare fraud in connection with a $12-million scheme to perform unnecessary medical procedures on Medicare beneficiaries, officials announced Thursday.

Dr. Donald Woo Lee, 54, of Temecula was also found guilty Wednesday of adulteration of a medical device.

According to the Department of Justice, evidence presented at the six-day trial revealed that, from 2012 to 2015, Lee recruited Medicare beneficiaries to his clinics and falsely diagnosed them with venous insufficiency, a condition that prevents veins in the legs from allowing blood to flow to the heart.

Lee then provided beneficiaries with “medically unnecessary vein ablation procedures” and billed the procedures to Medicare “using an inappropriate code in an attempt to obtain a higher reimbursement,” the Justice Department said. That tactic is known as “upcoding.”

Evidence also showed that Lee repackaged used single-use catheters, the Justice Department said.

Lee submitted roughly $12 million in claims to Medicare and received $4.5 million.

The doctor was arrested in 2016 as part of a nationwide investigation into federal healthcare schemes. More than 300 people were charged, including a pharmacist and several doctors and psychiatrists in Southern California. Lee was one of 22 people charged in Southern California.

Officials said the schemes involved more than $900 million in fraudulent billings and often targeted military families.

According to the Department of Justice, more than 4,200 people have been charged in fraud schemes since 2007. Collectively, the individuals have billed the Medicare program for roughly $19 billion.

Lee’s sentencing has been scheduled for March 19. The investigation also included the FBI, the Department of Health and Human Services and the U.S. Food and Drug Administration.