Durable Medical Equipment

In Texas, the owner of a durable medical equipment (DME) company was sentenced to 63 months in prison and ordered to pay $669,000 in restitution for conspiracy and health care fraud. The man fraudulently billed Medicare for motorized wheelchairs and accessories, and alternating pressure mattresses. Beneficiaries either did not receive any equipment at all or were provided with a less expensive item. In addition, the man paid recruiters between $200 and $500 for beneficiary’s personal information.

Practitioners

In Ohio, a podiatrist was sentenced to 78 months incarceration and ordered to pay $528,000 in restitution for conspiracy, health care fraud, and false statements. The podiatrist, after being reinstated to the Medicare program in 2002, billed Medicare for non-covered routine foot care. Patient charts contained no documentation other than the handwritten date of service. In 2000, the Department of Justice recommended that the podiatrist be excluded for failure to repay his Health Educational Assistance Loan. In order to avoid the exclusion, the podiatrist submitted a fraudulent provider application to Medicare listing the owner of his new company as his dying friend, who was also a podiatrist, and began billing under the false identity.

In Virginia, a podiatrist was sentenced to one year and one day in prison for mail fraud. The podiatrist billed for procedures performed at a surgery center when, in fact, the services performed were routine, and performed in the office. The address of the surgery center was actually a mailbox rental business located next to his office. Through his billing scheme, the podiatrist was reimbursed for facility-related charges such as pre-op and post-op rooms.

Child Support Enforcement

In Florida, a man was sentenced to 5 years probation and ordered to pay $47,000 in restitution for failure to pay child support. The man, who was ordered to pay support in 1987, gave numerous reasons for not making his support payments, including that he felt the custodial parent was capable of supporting herself and their minor child. The man’s last documented support payment was involuntary and occurred in May 1990. The investigation revealed that the man had changed his last name, and lived in at least four different States after leaving Florida.

Home Health Agencies

In Tennessee, a man who owned a home health agency (HHA) serving Medicare beneficiaries and an agency providing private duty nursing services to non-Medicare beneficiaries was sentenced to 24 months incarceration, part of which will be spent in a half-way house, and ordered to pay a $700 assessment for health care fraud and false statements. A decision on the amount of restitution the man must pay has been deferred. The investigation revealed that the man failed to disclose his nursing service agency as a related party on his HHA’s cost reports for years 1998, 1999 and 2000. In addition, costs for nursing services for non-Medicare beneficiaries were shifted to the HHA’s Medicare cost reports.