Prescription Drug Fraud

In Ohio, a woman was sentenced to 14 months in jail for theft of drugs. The woman, who was previously employed as a registered nurse at a small hospital, used her position to obtain information on patients who had recently been discharged and were receiving pain medication. Without authorization and under the guise of being a home health care nurse, she visited patients’ residences then searched for and stole their pain medications. Many of the victim patients were Medicare and Medicaid beneficiaries with serious illnesses including cancer.

Physicians and Other Health Care Professionals

In California, a psychologist, who was found guilty in a June 2004 trial, was sentenced to prison and ordered to pay $250,000 in restitution for charges related to fraudulent Medicare claims. The psychologist billed $1.3 million worth of psychotherapy services for developmentally disabled Medicare beneficiaries that were not rendered.

In Ohio, a podiatrist was ordered to pay $11,000 in restitution and fines for health care fraud. Between 1997 through 2002, the podiatrist improperly billed Medicare by falsely overstating that he had performed a more complex service when he actually performed routine nail care.

Other Cases of Interest

In Kansas, a claims processor for a private insurer was ordered to pay $3,000 in restitution for false statements. The woman improperly processed claims, causing Medicare payments to be processed as the primary insurance when, in fact, Medicare should have been the secondary payer.

Durable Medical Equipment

In Kentucky, an owner of a durable medical equipment company was sentenced to six months home detention and ordered to pay $708,000 in restitution for payment of kickbacks. From approximately 1992 to 2002, the man paid kickbacks to a physician and his office manager in return for patient referrals to his company for oxygen and oxygen-related products.