Crime & Courts

Alaska doctor defrauded Medicaid by $9 million through lab test scheme, charges say

An Alaska physician is facing felony and misdemeanor charges over accusations that he repeatedly billed the state’s Medicaid program for unnecessary tests he performed on patients’ biological samples, defrauding the program by over $9 million.

Dr. John D. Zipperer Jr., 49, ran over 1 million medically unnecessary tests on urine samples he submitted to a laboratory he owned in Tennessee, according to charges filed on Dec. 20.

Zipperer opened a clinic in Wasilla in 2012 and shortly thereafter expanded to other locations in the state, including Anchorage, Fairbanks, Soldotna and Eagle River. He opened the Tennessee laboratory in 2013. According to the charges, between August 2013 and September 2015, he was reimbursed about $9 million for laboratory testing — over 10 times the combined total that all other providers in Alaska were reimbursed in that same time period.

Zipperer required patients to submit urine samples during each office visit, regardless of their diagnosis or when they were last tested, the charges said.

He tested the samples at his own lab and submitted the claims to Medicaid, other insurance companies or cash-paying patients for about $3,000 to $8,000 per sample, according to the charges. Medicaid reimbursed Zipperer 10% to 20% of what he billed per sample, and the charges said private insurance companies reimbursed at higher rates, while cash-paying patients were stuck with the whole bill.

Investigators said they began looking into Zipperer after cash-paying patients complained to the State Medical Board.

“One patient received a $21,000 bill for laboratory tests Dr. Zipperer performed on her urine samples without her knowledge or understanding,” the charges said.

ADVERTISEMENT

Zipperer submitted tests from August 2013 until 2015, when charges said that Medicaid and other insurance companies “began catching on to the laboratory testing scheme.” The companies began disenrolling him or refusing payment, charges said. He closed the Tennessee lab in September 2015.

A formal state audit began in 2018 and charges state that Zipperer repeatedly refused to cooperate with investigators. He was sanctioned by the Alaska Department of Health and Social Services on Dec. 4, 2019, and the department required that he pay back $8,813,333 to the Medicaid program, according to charges.

Zipperer could spend up to 10 years in prison and face a fine of up to $100,000 if he’s convicted of medical assistance fraud. The company he operates was also charged and faces a sentence of up to $5 million and possible restitution, prosecutors said.

Anyone with information about the case is asked to call the state’s Medicaid Fraud Control Unit at 907-269-6279.

Tess Williams

Tess Williams is a reporter for the Anchorage Daily News, focusing on breaking news. Before joining the ADN in 2019, she was a reporter for the Grand Forks Herald in North Dakota and previously helped cover the Nebraska Legislature for The Associated Press. Contact her at twilliams@adn.com.

Sponsored