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FOX6 Investigators: The $10,000 doctor’s appointment

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MILWAUKEE (WITI) -- A Milwaukee area podiatrist with a record of cheating patients is still racking up patient complaints at a rate that dwarfs his peers.  A FOX6 Investigation has found state regulators have done nothing about it for the past six years.

FOX6's probe was prompted by a patient who objected to the staggering bill he received for a 90-minute visit to ease pain in his aging feet.  Craig Nickelbein was stunned by the amount of money the doctor billed to Medicare -- and he was incensed when he discovered the doctor has a long history of patient complaints and a prior suspension for fraud.

"There's a lot of people around here that would just love to whip him," Nickelbein said. "He's been so crooked over the years."

Dr. John Lanham, podiatrist, outside his Milwaukee clinic.

Dr. John Lanham, podiatrist, outside his Milwaukee clinic.

Nickelbein is talking about Dr. John S. Lanham, a podiatrist with offices in Brookfield, Elkhorn, Mequon and Milwaukee.

Last spring, he went to see Dr. Lanham at his Elkhorn clinic due to nagging foot pain caused by a benign growth called a neuroma.

"It's like walking on bunched up socks all the time," Nickelbein said.

The doctor gave him a pair of cortisone shots and sent Medicare the bill... for more than $10,000!

According to a series of benefit statements Medicare sent to Nickelbein, Lanham billed the government for 18 separate services in those 90 minutes, including six different charges for ultrasounds, two injections, two x-rays and electrical stimulation that Nickelbein says he never got.

The doctor even billed $500 for a pair of "plastazote foot inserts" that Nickelbein says Lanham cut out right in front of him, like an arts-and-crafts project.

CraigInserts2

Craig Nickelbein holds up the foot inserts that he says Dr. Lanham cut out with scissors during his appointment. Lanham billed Medicare $500.08 for the pair.

"Cut it out with scissors, here you go," Nickelbein said.

Most baffling of all were two charges to remove a bone pin, even though Nickelbein never had one.

"This guy should be stopped from practicing medicine," Nickelbein said.  "Pure and simple."

Thanks to Medicare and private insurance, Nickelbein didn’t have to pay a dime. So why is he complaining?

"I hate fraud," Nickelbein said.

He’s not alone.

"I was horrified, horrified," says another patient, who we'll call 'Belinda.'

Belinda wanted her identity concealed, but she, too, got a pair of so-called “custom orthotics” from Dr. Lanham.

"He literally pulled out scissors and cut it to the shape of the shoe I was wearing," Belinda said.

Lanham billed Belinda's insurance company $233 dollars for each one.

"A Dr. Scholl insert would have been far superior for $5," Belinda said.

For Sophia Ocasio, private insurance hardly covered any of her procedure to remove an ingrown toenail, leaving her with a $5,600 bill

"I had an ingrown toenail removed, I didn't have my foot removed," Ocasio said.

Ocasio is a part-time student working two jobs just to pay the rent.  The most expensive thing she’s ever paid for in her life is her 1992 Honda Accord. It cost $2,500.

Then there’s 'Lynn' - not her real name - who saw the doctor three times for a bone spur in her pinky toe.  The total bill was more than $17,000.

"It felt like somebody punched me in the stomach," Lynn said of the moment she opened her statement.

There’s hardly anyone more fed up than Steven Frydman, Executive Director of the Wisconsin Society of Podiatric Medicine.

dr frydman talks

Dr. Steven Frydman, Executive Director of the Wisconsin Society of Podiatric Medicine. He receives so many complaints about Dr. Lanham, he created a separate email folder to manage them.

"There is nothing we can do in an office on an initial visit that is worth that kind of money," Frydman said.

However, Frydman has no power to stop Lanham.  That responsibility falls on the Wisconsin Department of Safety and Professional Services.

In 2007, the state suspended Dr. Lanham for 270 days due to a pattern of cases involving “fraud and deceit.”  The suspension was lifted after just 90 days.

Since then 58 additional patients have filed complaints against Lanham.  In that same time, no other podiatrist in Wisconsin has gotten more than four.

"Wow... holy... what does that tell you? " Lynn asks, incredulously.

In agreeing to his suspension in 2007, Dr. Lanham did not admit to fraud, but rather to a series of “reckless coding errors.”  Just last month, he told the state’s consumer protection office those charges for removing a “bone pin” from Craig Nickelbein were caused by a clerk who “accidentally” billed the wrong code.

"I think you can make a coding error once," Frydman counters.  "You can even make it twice.  But this is a pattern that has been going on for over five or six years now. It's not an error. It's his way of getting around insurance to make as much money as he possibly can on each office visit."

Speaking of insurance, Frydman says that’s one of the most common complaints he hears about.  Patients routinely say they were led to believe their insurance would cover the visit.

Only to find out later, it didn’t.johnson

"I was really upset about it," Becki Johnson says.  She saw doctor Lanham for an ingrown toenail and thought her insurance would cover the procedure.  She asked if Dr. Lanham "takes" United Healthcare. 

"He said 'yes,'" Johnson recalls.

It wasn't until after she received the bill that she discovered Dr. Lanham was not in her insurance network at all and she was responsible for the entire bill.  She paid it, reluctantly.

"I can't prove that he told me he took United Healthcare, unless I recorded him without his knowledge," Johnson said.

FOX6 Investigators sent producers into two of Dr. Lanham’s clinics, each equipped with a hidden camera, and one important question:

FOX6 Producer: "I have United Healthcare."

Receptionist: "Okay?"

FOX6 Producer: "Will United Health... will I be covered?"

Receptionist: "Yes."

In fact, Dr. Lanham’s assistant in the Milwaukee office seems to reassure one of our  producers there’s nothing to worry about:

FOX6 Producer: "So, you`ve had other people with United Healthcare?" 

Receptionist: "Yes."

FOX6 Producer: "And they've always, okay.  They've always been pretty good about..."

Receptionist: "Yeah.  You know, there may be a responsibility from your part.  But it's not a big responsibility."

However, it wasn’t just his assistant who gave FOX6 that impression.  It was Dr. Lanham himself.

FOX 6 Producer: "Do you guys take United Health?"

Dr. John Lanham: "Yes."

"They didn`t say, 'Stop. You're not gonna be covered in here,'" Frydman said.  "They just took the card."

The truth is Dr. Lanham is not a part of the United Healthcare Network.

However, that’s something he and his staff will only tell you if you know the right question to ask.

FOX6 Producer: "Are you guys on the network?"

Receptionist: "No, we are not."

Otherwise, Dr. Lanham puts the onus on the patient to figure it out. He asks every new patient to fill out forms, including a billing agreement that says, "It is your responsibility to know if Dr. John S. Lanham is in your insurance network."

Sign the form, and you’ve agreed to pay whatever your insurance company won’t.

"He duped me!" Belinda said.

polcyn confronts lanham 4Dr. Lanham declined FOX6's repeated requests for an on camera interview. When FOX6 Investigators tried to catch up with him outside his Mequon office, he darted back inside.  FOX6 Investigators waited by his car for 45 minutes, then went in after him, leading to the following exchange at the door of Lanham's office:

FOX6 Investigator Bryan Polcyn:"Dr. Lanham, could we please speak to you?  Why won't you talk to me, Dr. Lanham?"

Dr. Lanham: "Excuse me.  This is private property."

Polcyn: "Why won't you talk to me?"

Lanham: "I'm on the phone."

Polcyn: "Why won't you talk to me?"

Dr. Lanham did not stop to answer questions, but rather shut the door and locked it.

"This guy is just a fraud," Nickelbein said.

For the past six years, state regulators have done nothing about it.

Of the 58 complaints filed against Dr. Lanham since 2007, 52 of them have been dismissed without any action.  The other six are still pending.

"They're not policing their own," Belinda said.

"They're letting him off the hook!" Dr. Steven Frydman said.

Craig Nickelbein's case is one of the six that are left.

"If you can do somethin', God bless you," Nickelbein said. "If you can't do anything? It's a shame."

"I seriously hope to God there is somebody out there who will stop him,” Lynn said.

"He has no business treating people!" Belinda added.

Since his suspension and reinstatement in 2007, Dr. Lanham has sued 33 patients in small claims court to collect unpaid bills.  The attorney who represented him in those cases told FOX6 he never lost a single contested case.  However, Randy Wynn won’t be representing Dr. Lanham anymore. That’s because Wynn is now under criminal investigation for pocketing money belonging to other clients to support a gambling addiction.  Wynn says he plans to surrender his law license.

Meanwhile, FOX6 has learned that a state investigator is "grouping" the remaining complaints against Lanham together into a single investigation.  While it's not clear what that means, that is what happened in 2006, the last time the state took disciplinary action against him.

A spokesman for the Wisconsin Department of Safety and Professional Services says grouping of cases does happen "from time to time" and that it is not necessarily an indicator of pending discipline.  Beyond that, he declined to comment, citing it as an open investigation.

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