Child Support Enforcement

In Ohio, after pleading guilty, a man was sentenced to 5 years probation and ordered to pay $106,000 in restitution for failure to pay child support for his three children. After leaving Ohio in 1995, using an alias name, the man began living as a female. In March 2003, he was arrested in California once OIG agents established his actual identity. In 1999, the man earned approximately $230,000 as a computer programmer.

Durable Medical Equipment

A woman, who was previously convicted by a Florida jury, was sentenced to 21 months confinement for false statements, health care fraud and conspiracy. The woman was also ordered to participate in a drug treatment program as well as an anger management program. In 2000, Medicare assessed the woman’s father with an $182,000 overpayment and began withholding money from his durable medical equipment (DME) company. In order to avoid repayment, he created a new DME company in the name of his daughter. According to the Medicare Supplier Number application, the woman asserted that she was the sole owner/manager of the new company, when in fact, her father was the de facto owner/manager and it operated exactly as it did under the previous name. The woman was also sentenced to an additional 12 months confinement to be served concurrently for assaulting an agent during her arrest relating to the health care fraud investigation. The woman’s father was previously sentenced in January 2003.

Physicians and Other Health Care Professionals

In New York, a physician and his nurse were sentenced for their involvement in a scheme to defraud the Government. The physician was sentenced to three years and 10 months incarceration and ordered to pay $227,000 in restitution. The physician was previously convicted during a jury trial for health care fraud, conspiracy to distribute and dispense controlled substances, illegal distribution and dispensation of controlled substances, and aiding and abetting. The nurse was sentenced to 6 months home confinement for health care fraud and conspiracy to illegally distribute Schedule II controlled substances. The physician submitted claims to Medicare indicating he had treated the patients and performed the service directly, when actually, a nurse treated the patients. To facilitate this scheme, the physician provided presigned prescription pads for her and other nurses to prescribe narcotic drugs to patients.

A New York psychologist was sentenced to one year and one day in prison and ordered to pay $500,000 in restitution for health care fraud. The psychologist paid a co-conspirator for the use of his provider number. Through this scheme, the psychologist was able to bill and receive payments from Medicare and private insurers for services never provided (nerve block injection treatments), along with physical therapy treatments the psychologist was not allowed to perform or bill. The co-conspirator was previously sentenced for his involvement in the scheme.

Employee Misconduct

In South Dakota, two former Indian Health Service (IHS) employees were each ordered to pay $3,000 in restitution for their submission of fraudulent travel vouchers. The two IHS employees submitted travel vouchers claiming mileage for a personally owned vehicle and for individual lodging expenses, but actually used a Government owned vehicle and shared lodging. The extra compensation they received was then shared.