Prescription Drug Fraud

In Pennsylvania, a pharmacist was sentenced to 12 months home detention and ordered to pay $12,000 in criminal fines for her involvement in a fraud scheme. While working at a pharmacy, she illegally distributed Percocet and OxyContin from October 2001 through November 2002. The pharmacist’s illegal activities were uncovered during an investigation of an employee of a family and substance abuse counseling center who was engaging in fraudulent billings to support a drug addiction. The employee of the counseling center was previously sentenced to 30 months incarceration and ordered to pay over $1 million in restitution.

Durable Medical Equipment

In Texas, a woman was sentenced to 46 months incarceration and ordered to pay $1.7 million for her guilty plea to health care fraud. Through her DME company, the woman fraudulently billed Medicare over $3 million worth of power wheelchairs and accessories from December 2002 to August 2003. Claims submitted to Medicare were either upcoded or were for equipment that was not provided at all. In addition, certificates of medical necessity used in the scheme were purchased from recruiters.

Medicaid Fraud

In Idaho, a woman was ordered to pay $129,000 in restitution for conspiracy to commit health care fraud. The woman owned and was a therapist at a counseling center. The woman and her co-conspirator submitted fraudulent claims to Medicaid for case management services they did not provide. In order to submit the fraudulent claims, Medicaid numbers were obtained from their friends, family, and neighbors.

In South Dakota, a woman was sentenced to 30 days incarceration and ordered to pay $48,000 for failing to disclose assets held by an individual for whom she had power of attorney. This individual resided in a nursing home and received Medicaid benefits to which she would not have otherwise been entitled. She had been placed in the nursing home in 1999 and began receiving Medicaid benefits in 2001 based on the false information.