Testing Laboratory Co-owner Sentenced for $3.8 Million in Fraudulent Billing

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 held out as a clinical testing laboratory, and which was in the same building and used 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 forth 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. The misrepresentations also included claims that AGM stopped lab running samples and transferred its employees to Genotec in July of 2015, and that Genotec did not begin running samples until July of 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, AGM, to Genotec.

Himpler and Sicuro and other health care providers at AGM ordered urine toxicology tests for patients and referred those tests to AGM's lab and Genotec, which in turn sent the samples to outside "reference" laboratories. Both men knew AGM and Genotec did not have the necessary testing equipment to confirm the amount of given toxin in the urine testing to a high degree of certainty, Himpler's plea says. They then billed health insurers for the testing, despite knowing that Medicare, Medicaid and many private insurers bar "pass-through billing," or billing for tests performed by others.

When health insurers became resistant to paying Genotec claims, Himpler and Sicuro in March of 2015 created another laboratory company, Midwest Toxicology Group LLC, for the purpose of billing health insurers. Midwest was a lab in name only and was not authorized to perform tests on human specimens. Himpler and Sicuro never obtained a CLIA certification or any lab equipment for Midwest. In many instances, Himpler caused Genotec and Midwest to each submit claims for the testing of the same specimen obtained from the same person on the same day of service. The pair also falsely used 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 in pass-through billing and $2.4 million in split billing.

"Today's sentencing of Dr. Carlos Himpler demonstrates that HHS-OIG will continue to hold individuals who exploit federal health care programs accountable," said Linda T. Hanley, Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). "Health care providers have a responsibility to submit accurate and honest claims to federal health care programs, to ensure that these resources are available for eligible patients."

Himpler, now of Baton Rouge, Louisiana, pleaded guilty in February in U.S. District Court in St. Louis to a felony conspiracy charge.

Dr. Sicuro pleaded guilty in November 2022 and has satisfied the restitution owed. He also agreed to forfeit $3.1 million in assets.

The FBI and the U.S. Department of Health and Human Services Office of Inspector General investigated the case. Assistant U.S. Attorneys Dorothy McMurtry, Amy Sestric and Kyle Bateman prosecuted the case.