South Carolina

SC chiropractors accused of hatching scheme to defraud BlueCross BlueShield

Two S.C. chiropractors will go on trial Monday on federal charges that they cooked up a fraudulent patient-billing scheme to cheat BlueCross BlueShield out of hundreds of thousands of dollars.

If convicted of health care fraud, chiropractors John Pienkos II and Alexander Tomovski, who operated a clinic in Conway, could face up to 10 years in prison.

According to the charges, from 2012-16, the two chiropractors conspired to carry out an illegal scheme whereby patients covered by BlueCross BlueShield made multiple visits to their clinic until they reached the coverage limits of their health insurance, “regardless of medical necessity.”

Under this scheme, which involved numerous patients, the chiropractors were able to excessively bill Columbia-based BlueCross BlueShield of South Carolina to the tune of at least $399,000, according to their indictment.

“The defendants’ entire business model was based on money, not chiropractic treatment,” federal prosecutors say in court records.

Defense lawyers Debbie Barbier and Mark Moore of Columbia say the charges are “baseless allegations” and the chiropractors only engaged in “lawful billing practices,” according to court records. Moreover, government investigators harassed witnesses and mischaracterized their testimony in grand jury proceedings, they say.

Chiropractors specialize in therapy for back, neck and other aches by massages and physical manipulation of the body. Technically, they are not medical doctors but they undergo extensive training and must be licensed.

According to court records, the trial — which will be in Florence and is expected to take up to a week and a half — will feature testimony by other chiropractors about billing practices, as well as testimony by health care workers employed by the Conway chiropractic clinic. Dozens of witnesses, including FBI investigators, are expected to testify.

The prosecutors in the case are assistant U.S. attorneys Winston Holliday and Will Lewis of Columbia.

U.S District Court Judge Bryan Harwell will preside.