Practitioners

In Washington D.C., an ophthalmologist was sentenced to 18 months in prison, 6 months home detention and ordered to pay over $1 million in restitution and a $50,000 fine for health care fraud and filing a false tax return. The ophthalmologist billed Medicare, other Federal health care programs and private insurers for services either not provided or not medically necessary. In addition, the ophthalmologist paid personal expenses and salaries to his children and housekeeper with funds from his medical practice and falsely recorded these payments on corporate records as legitimate business expenses. He also took charitable deductions on his income tax returns for contributions he made to a non-profit organization that were used, in part, to pay for a family vacation.

Transportation Fraud

In West Virginia, a woman and her billing company were sentenced related to a scheme to submit false claims to the Medicaid program. The billing company was sentenced to 5 years probation and ordered to pay $353,000 in restitution; the owner of the billing company was ordered to pay a $500 fine. The investigation revealed that the Medicaid program was routinely billed twice for each ambulance transport service provided.

Employee Misconduct

In North Carolina, a former Regional Administrator for the Centers for Medicare & Medicaid Services (CMS) was sentenced to 180 days of home detention and ordered to pay $60,000 in restitution and a $5,000 fine for false statements to obtain Federal employee’s compensation. In addition, she entered into a settlement agreement and agreed to pay an additional $80,000. The former CMS employee was allegedly injured at work in 1999 and until the end of 2006 received a total of $270,000 from the Department of Labor’s Office of Workers’ Compensation Program. An investigation revealed that approximately from January 31, 2002 through January 31, 2006, she knowingly and willfully withheld employment information and provided false statements on documents submitted to the Department of Labor in order to receive disability compensation. Though she claimed to be partially disabled, the woman owned and ran a bed and breakfast where she performed nearly all aspects of operating the business including landscaping and cooking.