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Prescription
Drug Fraud
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| October 2004 |
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In Pennsylvania, a pharmacist was sentenced to 12 months home detention and ordered to pay $12,000
in criminal fines for her involvement in a fraud scheme. While working at a pharmacy, she illegally
distributed Percocet and OxyContin from October 2001 through November 2002. The pharmacist’s
illegal activities were uncovered during an investigation of an employee of a family and substance
abuse counseling center who was engaging in fraudulent billings to support a drug addiction. The
employee of the counseling center was previously sentenced to 30 months incarceration and ordered
to pay over $1 million in restitution.
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Durable
Medical Equipment
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| October 2004 |
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In Texas, a woman was sentenced to 46 months incarceration and ordered to pay $1.7 million for
her guilty plea to health care fraud. Through her DME company, the woman fraudulently billed Medicare
over $3 million worth of power wheelchairs and accessories from December 2002 to August 2003. Claims
submitted to Medicare were either upcoded or were for equipment that was not provided at all. In
addition, certificates of medical necessity used in the scheme were purchased from recruiters.
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Medicaid
Fraud
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October 2004
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In Idaho, a woman was ordered to pay $129,000 in restitution for conspiracy to commit health
care fraud. The woman owned and was a therapist at a counseling center. The woman and her co-conspirator
submitted fraudulent claims to Medicaid for case management services they did not provide. In order
to submit the fraudulent claims, Medicaid numbers were obtained from their friends, family, and
neighbors.
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In South Dakota, a woman was sentenced to 30 days incarceration and ordered to pay $48,000 for
failing to disclose assets held by an individual for whom she had power of attorney. This individual
resided in a nursing home and received Medicaid benefits to which she would not have otherwise
been entitled. She had been placed in the nursing home in 1999 and began receiving Medicaid benefits
in 2001 based on the false information.
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