Psychiatric and Psychological Services

In Pennsylvania, an owner/operator of a mental health facility was sentenced to 5 years in prison and ordered to pay over $280,000 in restitution and fines after being found guilty on all charges contained in a 49-count indictment. The woman and her company fraudulently obtained individual and group provider identification numbers from Medicare and then used those numbers to submit false and fraudulent claims for psychiatric and psychotherapy services. An investigation revealed that services were not rendered as billed or provided by licensed professionals.

Prescription Drug Fraud

In Virginia, a man received a 32-year suspended prison sentence provided he serve 10 days in jail and was ordered to pay $1,200 in restitution for obtaining prescription drugs by fraud and identity theft. Between January and August 2006, the man used an illegally-obtained Medicare Part D prescription card at pharmacies located in Virginia and Tennessee to obtain Schedule III and IV pain medications. The prescription card belonged to a Virginia beneficiary unknown to the defendant.

Clinics

In Florida, a woman was sentenced to 54 months in jail and ordered to pay $3.3 million in restitution for her involvement in a health care fraud scheme. The woman, who owned and operated a clinic, billed Medicare for fraudulent infusion therapy services and paid kickbacks to beneficiaries for the use of their Medicare number in order to fraudulently bill Medicare.

Durable Medical Equipment

In Florida, the owner of a durable medical equipment (DME) company was sentenced to 30 months in jail and ordered to pay $1.4 million in restitution for health care fraud. From April 2006 through October 2006, the DME company owner fraudulently billed Medicare for DME that was never ordered by physicians or provided to beneficiaries.

Practitioners

In Ohio, a podiatrist was sentenced to 1 month in jail, 6 months of home detention and ordered to pay $120,000 for health care fraud. The podiatrist submitted claims to Medicare and Medicaid using another podiatrist's provider number in order to circumvent an offset for overpayment he owed Medicare for services he provided while he had been excluded. The podiatrist was previously excluded after failing to repay his Health Education Assistance Loan.