Durable Medical Equipment

In Tennessee, the owner of a Texas durable medical equipment supplier was sentenced to 18 months in prison and ordered to pay $432,000 in restitution for violating the anti-kickback statute. Investigation revealed that the owner paid kickbacks of $1,000 for each certificate of medical necessity (CMN) she received. The CMNs were then used to bill Medicare for motorized wheelchairs for patients who had no need for the wheelchair. Patients either received no wheelchair at all or were provided with a less expensive scooter.

Other Cases of Interest

In Michigan, an attorney specializing in health care law was sentenced to 13 months incarceration and ordered to pay $98,000 in restitution for mail fraud. The attorney was hired by a physician group to negotiate a contractual joint venture agreement with a physical therapy company. As part of the negotiations, he was tasked with obtaining an official advisory opinion from OIG to ensure that the arrangement would not violate the anti-kickback statute. However, he did not request and obtain an advisory opinion from OIG but instead prepared false documents on copied OIG letterhead which falsely stated the joint venture met with the approval of OIG.

Home Health

In Virginia, a personal care aide, who devised a scheme to defraud the Medicaid program, was sentenced to 5 months in jail and ordered to pay $58,000 in joint and several restitution. Three co-defendants were previously sentenced for their involvement in the fraud scheme and held jointly liable for the restitution amount. The personal care aides caused the Medicaid program to pay for services not rendered by falsifying time sheets and personal care aide logs.

Prescription Drug Fraud

In West Virginia, pursuant to his guilty plea, a physician was sentenced to 1 month imprisonment and ordered to pay a $5,000 fine for obtaining prescription drugs by fraud. The physician was also ordered to participate in a program of testing, counseling, and treatment for drug and alcohol abuse. The physician used drug samples that he obtained from pharmaceutical companies for his own personal use.