Durable Medical Equipment

In Connecticut, pursuant to his guilty plea, an owner of two hearing aid stores was sentenced to 12 months and 1 day in prison and ordered to pay $151,000 in restitution for health care fraud. The investigation revealed that the man submitted claims to private insurers for hearing aid products and/or services that were false. In addition, the man is facing State level charges for defrauding the Medicaid program for the same type of billing scheme.

Practitioners

In Georgia, a respiratory therapist was sentenced to 5 years in prison and ordered to pay $2.7 million in restitution for conspiracy to commit health care fraud. The respiratory therapist, who worked in a hospital, provided false blood test results for patients so a DME provider could in turn bill Medicare and Medicaid for unnecessary oxygen treatments.

In Colorado, a licensed clinical social worker (LCSW) was sentenced to 6 months of home detention and ordered to pay $63,000 in restitution for mail fraud. The LCSW billed Medicare for counseling services never rendered. Investigation revealed that the LCSW billed for more than 150 dates of services for a beneficiary that she actually only saw once. Medicare also denied claims billed for dates of services for 2 of her patients that occurred after their dates of death.

Medicaid Fraud

In Wisconsin, a woman was sentenced to 5 years in prison and ordered to pay $321,000 in restitution for defrauding the Wisconsin Medicaid program. The woman owned and operated a company that she founded to provide pre-natal and child care coordination services. An investigation revealed that the woman billed the Medicaid program for services never rendered or for non-covered services. In addition, the woman attempted to cover-up the fraudulent billings by paying employees to fabricate records to support the fraudulent claims. Four co-defendants were previously sentenced related to their role in fabricating documents.