Johnstown plastic surgeon pleads guilty to Medicaid, insurance fraud
HARRISBURG — A Johnstown plastic surgeon who billed Medicaid and private insurers for cancer treatments — even when the growths were not cancerous — pleaded guilty to two felony counts of Medicaid and insurance fraud, according to Attorney General Josh Shapiro.
Dr. Daniel R. Nevarre, 58, waived his preliminary hearing and was sentenced to six to 23 months of house arrest, followed by three years of probation, Shaprio said in a press release.
Nevarre was the owner and operator of Plastic Surgical Associates of Johnstown, which he sold in 2017.
“When people commit Medicaid fraud, they’re stealing tax dollars from people who are in real need of healthcare services,” Shaprio said. “Insurance fraud is also a serious crime that drives up premiums for everyday Pennsylvanians. This plastic surgeon gamed the system for his own profit. I won’t tolerate that, and we will hold him accountable.”
According to Shapiro, employees noticed Nevarre was billing all tissue samples as cancerous, even when subsequent lab tests indicated the tissues were not. He also regularly up-coded routine procedures near the eye area as complex eyelid reconstructions — a surgery that requires at least a quarter of the eyelid to be reconstructed, Shapiro said.
Both of these fraudulent schemes, which employees began noticing in 2010, resulted in higher reimbursements to Nevarre and his practice.
The defrauded insurance providers include Highmark Blue Cross/Blue Shield, UPMC, Medicare, and the Pennsylvania Medical Assistance (Medicaid) Program.
Nevarre was ordered to pay full restitution to the providers as a condition of his sentence.