Practitioners

In New York, a dentist was sentenced to 18 months in jail and ordered to forfeit $5 million in assets as a result of being found guilty of defrauding the Medicaid program. The dentist, who became excluded from participating in the Medicaid program in 1995, devised a scheme to maintain his practice which was comprised of 95 percent Medicaid patients. So he could continue treating his Medicaid patients, he hired junior dentists with valid Medicaid provider numbers to perform basic procedures and paid them on a per diem basis. The excluded dentist provided the more complex procedures and billed Medicaid for all the services performed in the practice under the provider numbers of the junior dentists. In an attempt to cover up his scheme, the dentist created management companies so he could deposit the Medicaid funds received that were in the names of the junior dentists.

In Pennsylvania, a radiologic technologist was sentenced to 577 hours of community service and ordered to pay $22,000 in restitution for false statements relating to health care matters. The technologist performed mammograms provided at a clinic without first performing required daily and weekly quality control tests on mammogram machines. As required by Federal law, quality control tests are to be performed to ensure machines are operating within acceptable limits. The investigation revealed that in order to conceal the fraud, the technologist created false records during a 24-week period. As a result, mammograms performed on 577 women could not be considered reliable and the women had to undergo repeat screenings.

Durable Medical Equipment

In Florida, a durable medical equipment (DME) company owner was sentenced to 10 month in prison and ordered to pay $11,000 in restitution for conspiracy to violate the anti-kickback statute. In 2002, the DME company owner entered into an improper relationship with an owner of a pharmacy. The investigation revealed that the DME company owner received illegal kickback payments in exchange for each patient referral.