SIOUX CITY -- Federal authorities in Michigan are conducting a criminal investigation into a Sioux City plastic surgeon who already is accused of filing more than $64,000 in fraudulent Medicare and Medicaid claims while he practiced there.
Dr. Adam Smith is accused of filing approximately 72 false Medicare claims and 17 false Medicaid claims from 2011-14 while practicing in Traverse City, Michigan, where he operated Borealis Plastic Surgery.
Smith practiced in Michigan before he came to Sioux City. The Iowa Board of Medicine in July charged Smith with professional incompetency, saying he provided inappropriate surgical care to 17 patients during a three-year period. The board's charging document said Smith engaged in harmful practices, unethical or unprofessional conduct, inappropriate prescribing of drugs, improper medical record management and making misleading or deceptive representations to patients between December 2014 to September 2017.
A complaint filed in U.S. District Court in Michigan's Western District alleges that Smith performed unnecessary surgeries -- in some cases repairing nonexistent injuries -- billed for procedures he never performed and used incorrect billing codes so that the procedures would qualify for reimbursement from the state and federal health care programs. Smith also is suspected of billing for larger or more complex procedures than he performed in order to increase his financial reimbursements.
"Defendants engaged in a pattern or practice of submitting false claims for payment to federal health care programs, including Medicare and Medicaid, intending these programs to rely upon these claims for payments," federal attorneys said in the complaint, filed in December.
The government has calculated that Smith was paid a total of $64,377 as a result of his alleged fraudulent filings: $58,452 from Medicare and at least $5,925 from Michigan's Medicaid program.
Proceedings in the civil case have been stayed while federal authorities pursue a parallel criminal investigation into Smith, who has not been indicted.
Ryan Cobb, civil division chief of the U.S. Attorney's Office of the Western District of Michigan, declined to comment on the ongoing legal matters.
A hearing on the complaints against Smith in Iowa is scheduled for Oct. 17-18 before the state Medical Board in Des Moines.
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Citing confidentiality rules, Jim Graham, the medical board's chief investigator, said he couldn't comment on how many complaints the state received about Smith or if the board has received more complaints since the charges were made public. Graham said Smith may continue to practice while his case is pending.
Smith, who is affiliated with Tri-State Specialists in Sioux City, did not return a message left with his office. Tri-State CEO Lee Hilka also did not return messages seeking comment.
Smith practiced in Traverse City from 2011 through 2014 and had staff privileges at Munson Medical Center in Traverse City. During a routine review of Smith's patient charts in December 2012, reviewers noted "egregious" concerns about his documentation and coding and raised the possibility of fraud, setting off a more formal review process.
A May 2013 review found that in each case reviewed, "the documentation did not substantiate the clinical course of treatment," court documents say.
The hospital briefly suspended Smith's craniofacial surgery privileges in July 2013.
A second reviewer again noted possible fraudulent activity in Smith's filings.
Smith resigned his clinical privileges at Munson in January 2014, the same year he began practicing in Sioux City. In his resignation letter, he sought Munson's agreement not to report his resignation to national or state authorities. Munson did not accept that condition and told Smith that any reporting obligation was "independent and separate from his resignation," court documents said.
Dale Killingbeck, a Munson spokesman, said he could not comment on whether the hospital reported Smith's actions to authorities.
"Munson was never the target of any investigation involving Dr. Smith," Killingbeck said.
After Smith had left his practice in Michigan, two former patients filed separate malpractice lawsuits against him in 2015. Both were later settled out of court, and terms of the settlements are confidential.
Smith also faces three lawsuits in Woodbury County from former patients who claim he botched their surgeries.