Dr. Kenneth Fishberger, of East Setauket, pleads guilty in medical fraud scheme
A Long Island internist ordered hundreds of medically unnecessary brain scans and received nearly $50,000 in cash kickbacks, he admitted in a Boston federal court Thursday.
Dr. Kenneth Fishberger, 75, of East Setauket, pleaded guilty to one count of conspiracy to commit health care fraud before Federal Judicial Service Judge Nathaniel Gorton, of the U.S. District Court of Massachusetts.
The doctor, who formerly managed a practice on Belle Terre Road in Port Jefferson, admitted that between June 2013 and December 2019 he conspired with the owner and a salesperson of a medical diagnostics company operating in Massachusetts to order 480 transcranial doppler scans in exchange for $100 cash each, according to a copy of the plea agreement. The diagnostics company was not named in court papers.
The scheme led to more than $891,000 in fraudulent bills to Medicare and private insurance companies, prosecutors said in a press release.
Fishberger faces up to 10 years in federal prison when he is sentenced in February, prosecutors said, though the agreement states that prosecutors will recommend a lesser sentence.
As part of the plea agreement, Fishberger will also pay $342,876 in restitution and will forfeit the $48,000 he obtained in the scheme, court records show. The doctor is also subject to a fine of up to $250,000 and prosecutors will recommend one year of post-release supervision following incarceration.
TCD scans are ultrasounds that measure blood flow in parts of the brain, prosecutors said. In an agreed-upon statement of facts, Fishberger admitted "falsifying patient diagnoses" so that Medicare would pay for the tests.
The false diagnoses were prompted by representatives of the diagnostics company, who recommended in text messages that Fishberger report to insurance companies that patients had conditions involving blood flow in the back of the brain, court records show. There were only eight medical reasons for which Medicare would pay for TCD ultrasounds, according to the felony information.
“[Fishberger] signed many prescriptions and orders ... that a given patient had one of those conditions even though he had not and did not diagnose the patients with it," the statement of facts reads.
Fishberger received monthly cash payments based on the number of tests ordered in the prior month, he admitted in the statement of facts.
Prosecutors said that, on one occasion in December 2019, Fishberger was paid $900 in cash from a representative of the diagnostics company at a meeting near a local Starbucks, according to court records.
Fishberger’s attorney, Zachary Hafer, of Boston, could not be reached for comment.
The investigation into the scheme involved officials with the FBI and other federal agencies, including the IRS, Health and Human Services, the Postal Service and the Department of Labor, prosecutors said.
New York State records show Fishberger has practiced internal medicine since July 1976 and has been board certified in that area since 1980. The New York State Board of Professional Misconduct previously disciplined Fishberger in 2004 after he admitted violating the public health law by inappropriately prescribing opiates to patients and failing to maintain proper records of those prescriptions from 1991 to 2001, state records show.
In 2014, Newsday reported that Fishberger accepted payments from pharmaceutical companies while serving as cochair of a committee that recommended drugs to both Mather and St. Charles hospitals in Port Jefferson. He previously served as president of the medical and dental staff at Mather.
Fishberger is scheduled to be sentenced in Boston on Feb. 25.
Grant Parpan covers Suffolk County courts and federal courts for Newsday. A Long Island native, he joined Newsday in 2022.
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