Show-Me State Times

ST. LOUIS – U.S. District Judge Sarah E. Pitlyk on Tuesday sentenced a former St. Louis County health care company owner to 20 months in prison and fined him $100,000 for submitting more than $3.8 million in fraudulent claims to Medicare, Medicaid, and private health care benefit programs.

Carlos Himpler, now 44, owned or operated a series of health care-related businesses. Himpler’s co-defendant, Dr. Franco Sicuro, owned Advanced Geriatric Management LLC (AGM) in Creve Coeur, Missouri. In the fall of 2014, Himpler and Dr. Sicuro decided to open an in-house testing lab at AGM. They also opened Genotec DX, which they presented as a clinical testing laboratory in the same building and using the same testing machine as AGM’s lab.

Himpler and Dr. Sicuro sought accreditation for both labs under the Clinical Laboratory Improvement Amendments (CLIA), which set quality standards for laboratories. They did not disclose that both labs would employ the same part-time employee who would perform tests using the same machine. To convince CLIA to grant Genotec a final certificate of compliance in November 2015, Himpler participated in causing Genotec to make misrepresentations to CLIA, including that Genotec’s testing hours “changed” so that they no longer overlapped with AGM's hours.

The misrepresentations also included claims that AGM stopped running samples and transferred its employees to Genotec in July 2015 and that Genotec did not begin running samples until July 2015. In reality, the AGM lab continued operating after July 2015 and Genotec started testing months before then.

The pair concealed Sicuro’s co-ownership of Genotec from Medicare, Medicaid and private health care insurers while referring urine specimens from Sicuro’s own practice at AGM to Genotec.

Himpler and Sicuro along with other health care providers at AGM ordered urine toxicology tests for patients and referred those tests to AGM’s lab and Genotec; these labs sent the samples to outside "reference" laboratories. Both men knew AGM and Genotec did not have the necessary equipment to confirm toxin levels with high certainty according to Himpler's plea agreement.

Despite this knowledge, they billed health insurers for these tests even though Medicare, Medicaid, and many private insurers prohibit “pass-through billing,” or billing for tests performed by others.

When health insurers became resistant to paying claims from Genotec in March 2015, Himpler and Sicuro created another laboratory company called Midwest Toxicology Group LLC solely for billing purposes without obtaining CLIA certification or any lab equipment for Midwest.

In several instances, Himpler caused both Genotec and Midwest to submit claims for testing the same specimen obtained from the same person on the same day of service using false information such as falsely applying Genotec’s CLIA number on claims submitted under Midwest's name.

Himpler admitted in his plea agreement that Medicare, Medicaid,and private health care insurers paid $1.4 million through pass-through billing practices plus an additional $2.4 million through split billing practices.

“Today’s sentencing of Dr.Carlos Himpler demonstrates that HHS-OIG will continue holding individuals accountable who exploit federal healthcare programs," said Linda T.Hanley Special Agent-in-Charge with U.S.Department Of Health And Human Services Office Inspector General(HHS-OIG). "Healthcare providers have responsibility ensuring accurate honest claim submissions federal healthcare programs ensuring resources available eligible patients."

Himpler now residing Baton Rouge Louisiana pleaded guilty February U.S.District Court St.Louis felony conspiracy charge

Dr.Sicuro pleaded guilty November2022 satisfied restitution owed agreed forfeiture$3 .1million assets

FBI U .S.Department Health And Human Services Office Inspector General investigated case Assistant U .S.Attorneys Dorothy McMurtry Amy Sestric Kyle Bateman prosecuted case