Practitioners

In California, a physician was sentenced to 30 months in prison and ordered to pay $558,000 in restitution for his involvement in a conspiracy to defraud the Medicare program. The physician wrote prescriptions and signed certificates of medical necessity for enteral nutrition products, motorized wheelchairs, and hospital beds that were not necessary and, in most cases, were not provided to beneficiaries. The physician received kickbacks from a DME company for each fraudulent prescription. In addition, the physician billed Medicare for treating patients who were recruited to come to his clinic with the promise of receiving free ensure products. Patients were then referred for ancillary services for which the physician received kickbacks from companies he referred patients to. In Illinois, a psychologist was sentenced to 22 months in prison and ordered to pay $170,000 in restitution for health care fraud. The psychologist billed Medicare for group and individual psychotherapy services that he did not provide. An investigation revealed that the psychologist, who visited facilities once or twice a week to conduct assessments, billed Medicare for psychotherapy services provided to patients 4 to 5 days a week that were either not performed as billed or were for dates of service when he was not actually present at the facilities. In 2005, the psychologist fled the U.S. to Israel. In April 2007, he was arrested by Israeli National Police and in September he was extradited back to the U.S. where he pled guilty.

Medicaid Fraud

In New Jersey, the owner/operator of several adult day care centers and his brother, who worked at the facilities, were sentenced to 6 months and 55 months in prison, respectively, for conspiracy to commit health care fraud. An investigation revealed that the brothers knowingly submitted inflated attendance figures causing the Medicaid program to pay for beneficiaries who never attended the day care centers. In February 2007, a $5.5 million civil settlement was reached with Horizon and its associated entities for the false billings to Medicaid.

Prescription Drug Fraud

In Washington D.C., a man was sentenced to 57 months imprisonment and ordered to forfeit $11,700 in cash and his vehicle for unlawful distribution of Oxycodone within 1000 feet of a school. In 2006, the man sold Oxycodone in front of an elementary school. After a search of the man's home, hundreds of pills of controlled substances were recovered.