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Durable
Medical Equipment
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| March 2006 |
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In Florida, a licensed orthotist and a patient recruiter were sentenced
for conspiring to commit health care fraud involving eight Miami-based
medical organizations. The orthotist was sentenced to 28 months in
prison and ordered to pay $1.8 million in restitution; he collaborated
with DME owners to provide signed documentation for orthotic devices
without ever examining the patient. The DME companies then billed for
custom-fitted devices when actually, a prefabricated device was provided.
The patient recruiter was sentenced to 22 months in prison and ordered
to pay approximately $4.2 million in restitution. As the primary recruiter
in the scheme, he paid Medicare beneficiaries for the use of their
personal information. The information was then provided to six DME
companies and to two pharmacies that, in turn, submitted fraudulent
claims to Medicare.
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Practitioners
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March 2006
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In New York, a dermatologist was sentenced to 20 years in prison
and ordered to pay $888,000 in restitution for unlawfully distributing
prescription narcotic drugs and health care fraud. In addition, a jury
found that the dermatologist’s conspiracy to distribute prescription
narcotics resulted in the death of a patient. The patient, who died
from an overdose of Dilaudid, saw the dermatologist approximately 24
times each month. Investigation revealed that for each visit, the dermatologist
billed Medicare for excisions of benign growths that were never performed.
Although Medicare was billed for over 2,000 surgeries, the patient
had no scars. It was revealed that the patient allowed the dermatologist
to submit the fraudulent bills, in exchange for prescriptions for controlled
substances and monthly cash payments of $700.
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Child
Support Enforcement
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March 2006
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In South Dakota, pursuant to his guilty
plea, a man was sentenced to 5 years probation and ordered to pay
$22,000 in restitution for failure to pay child support. After his
November 2005 arrest, he paid over $4,000 towards his child support
arrearage.
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Prescription
Drug Fraud |
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March
2006 |
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In Pennsylvania, three subjects were sentenced for their involvement
in conspiring to illegally import prescription drugs from the United
Kingdom. The subjects were each sentenced to 6 months home confinement
and ordered to pay various fines totaling $50,000. Through their
company, the subjects introduced illegally imported drugs, engaged
in wholesale distribution of prescription drugs without a Pennsylvania
license, and imported drugs not approved by the FDA. The drugs were
then billed to and paid for by Medicare and private insurers. As
part of the scheme, the subjects took orders for oncology medications
from medical practices and had the orders filled through a pharmaceutical
distributor in England. To avoid FDA and Customs authorities, the
imported drugs were packaged in plain boxes with no return address
and without the required Customs declaration.
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Misuse
of Grant Funds |
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March
2006 |
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In Washington, a former State Government social worker and his wife were sentenced related
to their scheme to defraud the Government. The man was sentenced to 46 months in prison and
ordered to pay $136,000 in restitution; his wife received a 30-day sentence. Between March
1998 and December 2004, the defendants diverted money from a Federally funded program designed
to help developmentally disabled foster care children and their families. As part of the scheme,
phony invoices were submitted through the man’s non-existent business purportedly for
services provided to children.
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