Durable Medical Equipment

In Texas, an osteopath was sentenced to 10 years in prison and ordered to pay $7.9 million in restitution for health care fraud and conspiracy. The osteopath signed preprinted prescriptions for motorized wheelchairs and certificates of medical necessity for beneficiaries she never saw. The documents were then provided to durable medical equipment company owners for $250 each.

Practitioners

In California, an audiologist was sentenced to 78 months in prison and ordered to pay $868,000 in restitution for her scheme to defraud. From January 1997 through July 2003, she billed Medicare and Medi-Cal for hearing aids, speech therapy and other related services without being licensed to dispense or render the service and in most cases, without a prescription from a referring physician. In addition, she billed for services purportedly provided to deceased beneficiaries.

In Michigan, pursuant to his guilty plea, a certified social worker (CSW) was sentenced to 100 hours of community service and ordered to pay $356,000 in restitution for health care fraud. Investigation revealed that the CSW billed Medicare and a private insurer for psychotherapy services that were never rendered.

Kickbacks

In Florida, a woman was ordered to pay $17,000 in restitution for her involvement in a kickback scheme. The woman paid kickbacks to an assisted living facility owner in exchange for allowing companies that she represented to provide services to the residents at the facility. Investigation revealed that the services that were being provided were billed as physical and occupation therapy however, the sessions typically only involved the therapists massaging and applying lotion to the beneficiaries’ shoulders. In addition, the woman paid kickbacks related to providing medically unnecessary medical equipment to residents.

Transportation Fraud

In North Carolina, an ambulance company and its owner were sentenced related to billing Medicare and Medicaid for dialysis patient transports that were not medically necessary. The owner was sentenced to 120 months in jail for health care fraud and to an additional 31 months in jail (to be run consecutively) for obstruction. The company and the owner were also ordered to pay $604,000 in joint and several restitution. Investigation revealed that emergency medical technicians were instructed to enter false information on ambulance reports falsely indicating patients required an ambulance when, in fact, they did not and could have been transported by other means. The owner also instructed billing personnel to submit claims indicating that patients were bed-confined when, in fact, they were not bed-confined. In addition, prior to an audit, the owner and the billing manager changed records to indicate medical necessity. The owner also intentionally withheld subpoenaed documents. The billing manager was previously sentenced and was ordered to pay $30,000, a portion of the joint and several restitution amount.