Durable Medical Equipment

In Texas, a man was sentenced to 13 months incarceration and ordered to pay $105,000 in restitution for health care fraud. Through his company, the man billed Medicare for power wheelchairs using a code that did not correspond to the wheelchair that was actually provided.

Physicians and Other Health Care Professionals

A Virginia physician was sentenced to 18 months incarceration and ordered to pay a $10,000 fine and $191,000 in restitution for health care fraud. From approximately January 2000 through October 2003, the physician submitted upcoded claims to Medicare and to a private insurer. In addition, claims submitted reflected comprehensive office visits that did not occur at all, or were for dates of service when the patient was only provided a prescription refill. The investigation began in July 2003 when the private insurer found that the physician’s billings were much higher than the average medical provider in the area. Shortly after the investigation began, a fire occurred at the physician’s medical office, which was determined to be a case of arson. Although a grand jury returned an indictment charging the physician with arson in connection with the fire, the Government dismissed the charge in exchange for his guilty plea to health care fraud.

Child Support Enforcement

In Maryland, a former U.S. professional basketball player was sentenced to 12 months and 1 day in prison, 12 months supervised release and ordered to pay $128,000 in restitution for failure to pay child support. The sentencing was the culmination of a 5-year Office of Inspector General (OIG) investigation during which the man was located in Spain and proof of his sizeable professional earnings in three foreign ball clubs was obtained through the OIG’s first-ever use of a Mutual Legal Assistance Treaty, an international agreement to facilitate judicial assistance. Through this process, the U.S. State Department and Spain’s Department of Justice were able to establish that the man had the ability to support a son during the same years in which he benefited from declaring the boy as a dependent on his income taxes.

In Louisiana, a man was sentenced to 2 years probation and ordered to pay a $2,500 fine for failure to pay child support. Prior to sentencing, he paid $64,750, representing 11 years of overdue arrearage, and also paid all future support payments due from the present through his daughter’s age of majority. In 2002, the man was operating a successful business with a taxable annual income of $184,000. In 2003, he earned a greater amount and owned two high-end sport utility vehicles, while his ex-wife and daughter lived in Government subsidized housing.

Employee Misconduct

In New Mexico, an Indian Health Service (IHS) contract employee was sentenced to 3 years supervised release and ordered to pay $26,000 in restitution for embezzlement. The man, who was supervising a construction project for IHS, embezzled money in order to add an addition to his home.