Medicare and private insurance companies rarely cover new treatments. Treatment provider Trina Health is currently attempting to navigate this common issue. Trina claims the treatment meets the criteria for a current billing code covered by insurance. As such, the clinic has been using this code to receive payment.
Insurance providers disagree and argue that the clinic is guilty of fraud.
More on Trina Health
Trina Health has offices across the country, including here in New York. In New York, the facility operates as the Diabetes Relief Center South Bronx. The group claims to have a new treatment for diabetes that can cure many of the complications that come with diabetes. A cure that does not require surgery.
The Artificial Pancreas Treatment involves the infusion of insulin through an IV. Medical professionals in the field have debunked the procedure. Medicare and private insurance companies have refused to pay for the treatment due to a lack of sufficient evidence to show a medical benefit.
Yet Trina continued to bill Medicare and private insurers.
From coverage battle to criminal charges
The clinics have faced serious trials from Medicare and insurance providers. 13 clinics have closed, siting audit investigations, reimbursement denials and fraud accusations.
The CEO of Trina Health, G. Ford Gilbert, also faces additional accusations. Dr. Thomas Aoki, a University of California Davis endocrinologist, claims the Artificial Pancreas Treatment was his creation. As such, he is suing Mr. Gilbert based on accusations of copyright and patent infringement as well as trade secret violations.
Alabama recently indicted Mr. Gilbert on charges of fraud and bribery. The charges are connected to an alleged scheme to get a law passed that would “force coverage” of the treatment. Alabama is accusing Mr. Gilbert of bribing lawmakers to change the policy to include required coverage.
Healthcare fraud a serious accusation
Healthcare providers are under constant scrutiny. Allegations of Medicare fraud are not uncommon and a defense must be structured to meet these accusations. This defense will serve to protect the personal and professional reputation of the accused. An attorney can provide guidance and help ensure this defense is tailored to the needs of the accused.