Practitioners
March 2008
- In Washington, a pharmacist was sentenced to 18 months in prison and ordered to pay $1.6 million in restitution for conspiracy to commit health care fraud and money laundering. The pharmacist and her husband owned a retail pharmacy with locations in Bellevue, Kent and Tacoma. The couple, who pled guilty to their involvement in the scheme, fraudulently billed the Medicaid program for drugs, diapers, gloves and incontinence supplies that were never provided to beneficiaries. As part of the conspiracy, the couple recruited Medicaid patients to their pharmacy by offering them gift certificates for free goods, and then created false records including physician prescriptions and delivery receipts. The pharmacist's husband was sentenced in November 2007 to 63 months in prison and is held jointly responsible for the $1.6 million restitution amount. In addition, the couple's former attorney and their business partner were sentenced related to their involvement in the scheme.
- In Michigan, a doctor was sentenced to 20 months in prison and ordered to pay $73,000 in restitution for his scheme to defraud Medicare and a private insurer. As part of the scheme, the doctor waited one year before he submitted claims, used original progress notes to generate additional claims, and then submitted the fraudulent claims for dates of service when no service was rendered. The doctor, who is a foreign national, faces possible deportation at the conclusion of his prison sentence.
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Misuse of Grant Funds
March 2008
- In Ohio, a man was sentenced to 27 months in prison and ordered to pay over $557,000 in restitution for mail fraud and aiding and abetting. The man was the owner of a non-profit agency that contracted with counties in Ohio to provide foster care services. The agency received Administration for Children and Families grant funds from the State of Ohio. The investigation revealed that the man diverted money from the non-profit agency into a for-profit business that he controlled. Money that he claimed paid for foster case services was actually routed to his own personal investment accounts. In addition, the man concealed his ownership in the business and provided false documentation to auditors.
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Durable Medical Equipment
March 2008
- In Texas, two durable medical equipment (DME) company owners were sentenced for their scheme to defraud the Government. One defendant was sentenced to 37 months in prison and ordered to pay $458,000 in restitution; the other defendant was sentenced to 30 months in prison and ordered to pay $446,000 in restitution. As part of their guilty pleas, the defendants admitted to conspiring with others to pay illegal kickbacks to a Dallas physician for fraudulent certificates of medical necessity (CMNs). The defendants paid the physician $200 for each fraudulent CMN which were then used to bill the Medicare program for power wheelchairs and accessories. The physician received a 16-month prison sentence for his role in a similar conspiracy to defraud Medicare.
- In Kentucky, a former owner of a durable medical equipment (DME) company pled guilty and was sentenced to 1 year of probation and ordered to pay $79,000 in restitution for false statements. In addition, the owner pled guilty on behalf of his company for false statements relating to health care matters. The investigation revealed that the DME company provided nearly all of its customers with a 3-piece back brace but billed Medicare and Medicaid for a more expensive post-surgical back brace. As part of the scheme, prescriptions for back braces were altered and then submitted to Medicare and Medicaid to support the claim for payment.
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Medicaid Fraud
March 2008
- In Oregon, a woman was sentenced to 39 months imprisonment and ordered to pay $108,000 in restitution after being convicted for charges of making false claims and theft. During the 3-day trial, evidence showed that the woman engaged in a scheme whereby she claimed to be providing in-home care to a Medicaid recipient who was actually only pretending to be disabled. The woman's co-defendant died prior to trial. For seven years, the women billed Medicaid for phantom services and then split the Medicaid payments.
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