Hospitals, Laboratories, and Clinics

In South Carolina, the remaining five physicians from a pain management center were sentenced for their roles in defrauding the Government. They were the last of ten individuals sentenced in a case that resulted in over 70 years total incarceration and ordered restitution totaling approximately $811,000. The doctors at the center prescribed controlled substances outside the usual course of medical practice and forced unnecessary tests on patients in order to submit fraudulent claims to Medicare and other health care plans. Narcotics were provided to patients after little or no physical exam, and doctors met with more than one patient at a time in an effort to increase the clinic’s revenue.

Durable Medical Equipment

In South Carolina, an owner/operator of a DME company was sentenced to 5 months in prison and ordered to pay $88,000 in restitution for health care fraud. From February 1998 through 2002, the woman submitted claims for repairs to wheelchairs and mechanical hospital beds that were never performed.

Physicians and Other Health Care Professionals

In New York, a man was sentenced to 24 months incarceration and ordered to pay $398,000 in restitution for health care fraud. Although he possessed a valid license as a clinical psychologist in Massachusetts, the man did not meet the criteria for licensure in New York but purported to be licensed in the State. Based on the Massachusetts license, he was able to obtain Medicare and private provider numbers. The man used these numbers to submit claims to Medicare that were upcoded, not rendered, or for telephonic services. For his private pay patients, he submitted claims as if the patients were treated in Massachusetts.

Medicaid Fraud

In Virginia, two operators of a cab service were sentenced to 27 months and 21 months in prison, respectively, for submitting claims to Medicaid for taxi services they did not provide. They were also ordered to pay $395,000 in joint and several restitution.