Hospitals, Laboratories, and Clinics

January 2005

In Texas, a woman was ordered to pay $964,000 in restitution for her involvement in a scheme to defraud. During a 6-month period, the woman and her co-defendant, who owned and operated two physical therapy clinics, billed Medicare for evaluations and services that were not performed, billed for services provided by unlicensed technicians without necessary supervision, and paid kickbacks to individuals that referred patients to the clinics. When the two clinics closed, the woman operated another clinic and continued her fraud scheme. In November 2004, the co-defendant was sentenced and held jointly responsible for $894,000 of the restitution amount.

In California, the owner of a laboratory company was sentenced to 10 months incarceration and ordered to pay $180,000 in restitution for health care fraud. The man billed Medicare for diagnostic tests, including echocardiograms and ultrasounds, which were not ordered by a physician and were never interpreted by a physician.

Physicians and Other Health Care Professionals

January 2005

In Washington, a doctor was sentenced to 12 months and 1 day in prison and ordered to pay $46,000 in restitution and a $100,000 fine for health care fraud. The doctor billed for services not rendered or for services that were upcoded.

Durable Medical Equipment

January 2005

In Florida, a man was sentenced to 18 months in prison for his involvement in a money laundering scheme. In addition, the man will be deported to Peru after his sentence. The man’s advertising company served as a vehicle to launder over $2.5 million in Medicare funds for eight Miami-based medical organizations. The investigation revealed that the DME companies and pharmacies involved in the scheme billed for equipment or services for beneficiaries who either had no need for, or did not receive, the equipment or services.