Durable Medical Equipment

In Florida, a licensed orthotist and a patient recruiter were sentenced for conspiring to commit health care fraud involving eight Miami-based medical organizations. The orthotist was sentenced to 28 months in prison and ordered to pay $1.8 million in restitution; he collaborated with DME owners to provide signed documentation for orthotic devices without ever examining the patient. The DME companies then billed for custom-fitted devices when actually, a prefabricated device was provided. The patient recruiter was sentenced to 22 months in prison and ordered to pay approximately $4.2 million in restitution. As the primary recruiter in the scheme, he paid Medicare beneficiaries for the use of their personal information. The information was then provided to six DME companies and to two pharmacies that, in turn, submitted fraudulent claims to Medicare.

Practitioners

In New York, a dermatologist was sentenced to 20 years in prison and ordered to pay $888,000 in restitution for unlawfully distributing prescription narcotic drugs and health care fraud. In addition, a jury found that the dermatologist’s conspiracy to distribute prescription narcotics resulted in the death of a patient. The patient, who died from an overdose of Dilaudid, saw the dermatologist approximately 24 times each month. Investigation revealed that for each visit, the dermatologist billed Medicare for excisions of benign growths that were never performed. Although Medicare was billed for over 2,000 surgeries, the patient had no scars. It was revealed that the patient allowed the dermatologist to submit the fraudulent bills, in exchange for prescriptions for controlled substances and monthly cash payments of $700.

Child Support Enforcement

In South Dakota, pursuant to his guilty plea, a man was sentenced to 5 years probation and ordered to pay $22,000 in restitution for failure to pay child support. After his November 2005 arrest, he paid over $4,000 towards his child support arrearage.

Prescription Drug Fraud

In Pennsylvania, three subjects were sentenced for their involvement in conspiring to illegally import prescription drugs from the United Kingdom. The subjects were each sentenced to 6 months home confinement and ordered to pay various fines totaling $50,000. Through their company, the subjects introduced illegally imported drugs, engaged in wholesale distribution of prescription drugs without a Pennsylvania license, and imported drugs not approved by the FDA. The drugs were then billed to and paid for by Medicare and private insurers. As part of the scheme, the subjects took orders for oncology medications from medical practices and had the orders filled through a pharmaceutical distributor in England. To avoid FDA and Customs authorities, the imported drugs were packaged in plain boxes with no return address and without the required Customs declaration.

Misuse of Grant Funds

In Washington, a former State Government social worker and his wife were sentenced related to their scheme to defraud the Government. The man was sentenced to 46 months in prison and ordered to pay $136,000 in restitution; his wife received a 30-day sentence. Between March 1998 and December 2004, the defendants diverted money from a Federally funded program designed to help developmentally disabled foster care children and their families. As part of the scheme, phony invoices were submitted through the man’s non-existent business purportedly for services provided to children.