Ambulance Companies

March 2003

In Illinois, a former owner of an ambulance service was sentenced to 27 months imprisonment and ordered to pay $600,000 in restitution for health care fraud. The man submitted claims for transports that were medically unnecessary. In addition, ambulance run records were altered to add services that were not provided to patients.

Child Support Enforcement

March 2003

In Arizona, a man was sentenced to 16 months in prison and ordered to pay $157,000 in restitution for failure to pay child support. The man is the author of a book that teaches techniques on how to appear poor or disappear completely and resurface under a new identity. The man used his own vanishing techniques for over 9 years and eluded paying his support obligation by hiding under assumed names, laundering money through family members and business associates, and by failing to pay income tax.

In Florida, a man was sentenced to 5 years probation and ordered to pay $120,000 in restitution for failure to pay child support obligation since July 1994. The man received more than $75,000 in workman’s compensation benefits from July 1994 through July 1997.

In Michigan, an orthopedic surgeon was sentenced to 30 days incarceration, 2 years probation and ordered to pay $61,000 in restitution for failure to pay child support. The restitution amount was paid at sentencing. The man, who falsified his financial affidavit to the court, was also ordered to pay fees submitted by the public defender.

In Illinois, a man was sentenced to 6 months incarceration and ordered to pay $47,000 in restitution for failure to pay child support. Although steadily employed while living in Missouri, the man never made a payment for his child who is now approaching 18 years old.

In Florida, a man was sentenced to 5 years probation and ordered to pay $39,000 in restitution for failure to pay child support. As part of a plea agreement, the man paid $5,000 at sentencing and was ordered to participate in a drug and alcohol rehabilitation program and to maintain employment.

In Ohio, a man was sentenced to 3 years supervised probation, 200 hours of community service and was ordered to pay $35,000 in restitution and a $500 fine for failure to pay child support. The man, who earned a moderate income, never made a voluntary support payment.

In Virginia, a man was sentenced to 6 months incarceration, 1 year supervised probation and ordered to pay $32,000 in restitution for failure to pay child support. The man, who was unemployed, received disability checks from the Social Security Administration. During the investigation, it was revealed that he filed for Chapter 13 bankruptcy.

In Wyoming, a man was sentenced to 5 years supervised probation and ordered to pay $24,000 in restitution for failure to pay child support. In July 2002, an arrest warrant was issued, and as a result, the man self-surrendered to agents in Missouri.

In Wyoming, a man was sentenced to 5 years probation and ordered to pay $22,000 in restitution for failure to pay child support.

In South Dakota, based on his guilty plea, a man was sentenced to 5 years supervised probation and ordered to pay $14,000 in restitution for failure to pay court-ordered child support.

In Wyoming, a man arrested in July 2002 was sentenced to 5 years probation and ordered to pay $11,000 in restitution for failure to pay child support.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $9,000 in restitution for failure to pay child support. He was also ordered to participate in a community corrections residential facility for at least 90 days.

In Arkansas, a man was sentenced to 5 years probation and ordered to pay $9,000 in restitution for failure to pay child support. The man, who never made a payment, frequently changed jobs in order to avoid paying his obligation.

Durable Medical Equipment

March 2003

In Florida, a man in control of several durable medical equipment (DME) corporations was sentenced to 84 months in prison and ordered to pay $14.4 million in restitution for his role in schemes to defraud Medicare and Medicaid. In addition, the court ordered a $14.8 million order of forfeiture against him. The man previously pled guilty on behalf of six DME corporations that were set up to launder money. Despite a temporary restraining order, the man and his co-conspirators continued to fraudulently bill Medicare and launder the proceeds of the fraud through offshore bank accounts.

In addition, a co-conspirator was sentenced to 1 year and 1 day in prison and ordered to pay $474,000 in restitution for conspiracy and submitting false claims. The sales representative received commissions from the sale of motorized wheelchairs, alternating pressure mattresses and related items. Another sales representative was ordered to pay $485,000 in restitution for conspiracy and submitting false claims to Medicare and Medicaid. The man received and distributed commission payments for other sales representatives working under his direction.

A New York couple who owned a durable medical equipment company were sentenced based on their guilt pleas. The husband was sentenced to 15 months incarceration and ordered to pay $210,000 in restitution for health care fraud. His wife was sentenced to 6 months in a halfway house and 6 months home detention for paying kickbacks to doctors. Although the owners and their staff provided Medicare and Medicaid beneficiaries with inexpensive soft back braces, they actually billed Medicare for expensive, firm body jackets. The wife provided the funding that was used to pay kickbacks to doctors for their referrals and prescriptions.

Employee Misconduct

March 2003

In Maryland, a former National Institutes of Health employee was ordered to pay $17,000 in restitution for conspiracy to use unauthorized access devices.

Kickbacks

March 2003

In Massachusetts, a physician was ordered to pay a $5,000 fine for conspiring to receive kickbacks from a pharmaceutical company. The physician conspired with a sales representative from the company to receive free samples of the prostate cancer drug, Lupron Depot, in return for his decision to switch his patients from another drug to Lupron. The physician, who received 30 free samples, not only switched patients to the drug, but also billed Medicare for the free samples.

In Montana, three people were sentenced for their involvement in defrauding the Indian Health Service (IHS) regarding the purchase of electrical supplies. An independent electrical supply salesman was sentenced to 60 months in prison and ordered to pay $18,000 in restitution. Former HIS employees were sentenced; one was sentenced to 12 months and 1 day in prison and ordered to pay $11,000 in restitution and the other was sentenced to 3 months home confinement and ordered to pay $1,000 in restitution. The salesman paid kickbacks to IHS employees in the form of cash, gifts and weapons for purchasing over-priced electrical supplies, most of which were unnecessary. In addition, to avoid the $2,500 individual government credit card purchase limit, orders for the electrical supplies were split.

Mental and Social Services

March 2003

Two owners of a community mental health clinic in Texas were convicted for submitting fraudulent Medicare cost reports for years 1995 through 1998. One defendant was sentenced to 60 months incarceration and the other defendant was sentenced to 96 months incarceration. They were ordered to make joint restitution in the amount of $2.8 million.

Physicians and Other Health Care Professionals

March 2003

A Pennsylvania podiatrist was sentenced to 12 months and 1 day imprisonment and ordered to pay $409,000 in fines and restitution. The podiatrist previously pled guilty to false statements relating to health care matters. During a 6-year period, the podiatrist billed Medicare for more than 20,000 nail avulsion surgical procedures when in fact the number was significantly lower.

In Illinois, a pharmacist was sentenced to 6 months incarceration and ordered to make restitution of $292,000 to three private insurance companies for providing false information related to her financial condition in settlement of a qui tam lawsuit. In May 2002, the pharmacist admitted that she was involved with a fire at her residence, resulting in her financial gain. The pharmacist was previously convicted and sentenced for defrauding Medicaid for submitting improper claims for pharmacy related services that were never rendered. Subsequent to her criminal conviction, she entered into a civil settlement with the government to resolve her civil liability in a qui tam lawsuit for the same misconduct; it was later revealed that she provided false information regarding her financial condition.

A New York physician was sentenced to 6 months imprisonment and ordered to pay $250,000 in restitution for health care fraud. The owner of a clinic billed Medicare using the physician’s Medicare provider number. In return for the use of his provider number, the owner of the clinic paid the physician $2,500 a month and let him utilize office space and billing staff at the clinic. As a result, the owner received payments from Medicare for physical therapy services he was not qualified or legally allowed to perform and for services that were not provided.

Prescription Drug Fraud

March 2003

In Illinois, a woman was ordered to pay $122,000 in restitution for health care fraud. The woman, along with others, conspired to steal the growth hormone, Serotim, from an AIDS clinic. The drug was then illegally distributed to individuals at body building gyms.

In Ohio, a doctor and two Medicaid recipients were sentenced for their role in an OxyContin distribution conspiracy. The doctor was sentenced to 8 years and 1 month in prison and ordered to pay a $15,000 fine for conspiracy to distribute a controlled substance. The doctor’s plea stemmed from a 49-count indictment charging him with various offenses including health care fraud and drug trafficking. The doctor initiated, organized and operated one of the largest, physician-directed, OxyContin distribution conspiracies in the United States. One of the Medicaid recipients was sentenced to 3 years supervised probation with 6 months electronic monitoring and the other was sentenced to 1 year in prison and ordered to pay a $500 fine.

Other Cases of Interest

March 2003

In Pennsylvania, the owner of a billing service was ordered to pay $12,000 in restitution for making a false statement of material fact in an application for a benefit or payment under the Medicare program. The man was hired by the executor of a deceased physician’s estate to complete billings for services and was paid between 25 and 33 percent for anything he collected from Medicare. As a result, the man upcoded claims, unbundled claims and billed for services that had already been paid. He also billed for dates of service that occurred after the physician’s date of death.