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June 28, 2024
Health Law Weekly

Owners of Holistic Health Care Center Charged with Fraud Scheme

  • June 28, 2024

Brandon Nowak and Jason Simmons, co-owners of Alternative Integrated Medicine, LLC (doing business as AIM Health), were charged in federal court with defrauding federal and private health care insurance providers out of nearly $1.9 million by submitting fraudulent claims for reimbursement for services that were not provided, U.S. Attorney for the District of Rhode Island Zachary A. Cunha announced June 19.

According to a press release, at Nowak’s direction, and with Simmons’ knowledge, AIM Health allegedly electronically submitted for payment claims for services that did not occur or were not covered.

Additionally, AIM Health allegedly submitted reimbursement claims for acupuncture and evaluation and management office visits when the actual services provided were massages given by licensed massage therapists (a non-covered service); billed for high-complexity office visits without providing that level of service; modified codes on reimbursement forms to avoid triggering automatic denials for payment for services that were either not provided or medically unnecessary; and billed for covered and non-covered services rendered by uncredentialed providers under the provider numbers of credentialed providers.

An indictment contains allegations only and a defendant is presumed innocent unless and until proven guilty.