Data Clerk: Mistakes May Happen

Prosecution Rests Case in Sharp Trial

By BEN SIMMONS, Staff Writer
The former data entry clerk for Pocahontas Medical Clinics testified Monday that she was never instructed by Dr. John C. Sharp to upcode billing levels for patients and said she often made typographical mistakes when entering the billing codes. Other witnesses testified they knew Sharp was billing for services he shouldn’t have.

The government rested its case Monday after calling 13 witnesses to testify over a five-day span, in which several hundred pieces of evidence were introduced to the jury. The defense will begin calling witnesses today at 9 a.m. before U.S. District Judge Irene Keeley.

Sharp, 67, of Marlinton, is accused of 29 counts of health care fraud, in which he allegedly obtained approximately $570,434.46 by defrauding Medicare, Medicaid and West Virginia workers’ compensation.

The case is being prosecuted by Assistant United States Attorneys Alan McGonigal and Randolph Bernard. Attorneys Joel Hirschhorn of Coral Gables, Fla., Dorwin Wolfe of Elkins, and Thomas Dawson of Leavenworth, Kan., are representing Sharp.

During Monday’s proceedings, the government called four witnesses to testify including Melissa Hammonds, the former data entry clerk for Pocahontas Medical Clinics; Elizabeth Chestnut, the former receptionist; Lois Workman, who oversaw billing and medical coding; and Brandy Wooddell, a nurse assistant.

Some of the most compelling testimony came from Hammonds, who told the jury Sharp never asked her to increase the level of billing. She said Sharp gave her the fee tickets to enter for billing and if he would have charged for a higher service rate than rendered, she would not have known.

Hammonds told the jury she was responsible for entering all the fee tickets for both the Marlinton and Green Bank clinics. She said she found the job to be very difficult at times because of a heavy workload combined with distractions, multitasking and illegible handwriting on the fee tickets.

According to her, the office was “chaotic” at times and typographical mistakes were often made when entering the billing codes. She said the mistakes were never intended to defraud anyone or commit a crime.

“Looking back, I probably wasn’t qualified to do the job,” Hammonds said.

Throughout the trial, Hirschhorn has maintained the evidence would prove Sharp’s conduct was not criminal in nature, but innocent errors. He claims the mistakes were made by office staff when entering the billing codes.

During her testimony, Chestnut told the jury she became concerned with Sharp’s billing procedures after watching an instructional video on Current Procedural Technology codes at a training session hosted by Sharp at the Morning Glory Inn. She said Sharp was billing for time spent calling in prescriptions and coordinating services for patients over the telephone.

“When I heard it had to be face to face, it hit me like a ton of bricks — this is just not right,” Chestnut said.

She said she was told the telephone billing was done for the patient’s benefit, so the doctor would know what had occurred since the last visit and could follow up appropriately.

Chestnut told the jury Sharp always made time for his patients. She said he always returned telephone calls and never turned anyone away because they could not afford services.

“He often wrote off patient’s balances when they were large,” she said.

Workman also told the jury she had concerns with Sharp’s billing, but never confronted him. She said Sharp wrote the code he wanted billed on the fee tickets.

“I didn’t have any type of medical background,” Workman said. “I didn’t see any reason for me to question the doctor without that type of knowledge.”

Wooddell told the jury Sharp instructed her to log all prescription calls for billing, but she stopped after finding out it was not billable. She said Sharp did not argue with her when she confronted him.

“I told him I would no longer bill for prescription calls,” Wooddell said. “I had learned it was wrong.”

According to the indictment, Sharp allegedly devised a scheme to defraud health care benefit programs by billing them for services that were not rendered beginning in May of 1998 and continuing through January 2006. He also caused the programs to pay a higher rate of reimbursement than was warranted in the light of services that were rendered, the indictment states.

The indictment alleges that Sharp obtained approximately $79,969.20 from Medicare, approximately $88,321.18 from Medicaid and approximately $90,201.20 from West Virginia workers’ compensation by submitting claims for services that were not rendered. The indictment also states that he obtained $161,856.18 from Medicare and $150,086.88 from Medicaid as a result of submitting claims which misrepresented the level of office visit and service rendered.

Sharp is employed by Pocahontas County Medical Clinics.

Testimony will resume Tuesday at 9 a.m. at the U.S. District Court in Elkins. The trial is expected to wrap up next week.