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Durable
Medical Equipment
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| May 2006 |
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In Texas, an osteopath was sentenced to 10 years in prison and ordered
to pay $7.9 million in restitution for health care fraud and conspiracy. The
osteopath signed preprinted prescriptions for motorized wheelchairs and
certificates of medical necessity for beneficiaries she never saw. The
documents were then provided to durable medical equipment company owners
for $250 each.
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Practitioners
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May 2006
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In California, an audiologist was sentenced to 78 months in prison
and ordered to pay $868,000 in restitution for her scheme to defraud.
From January 1997 through July 2003, she billed Medicare and Medi-Cal
for hearing aids, speech therapy and other related services without
being licensed to dispense or render the service and in most cases,
without a prescription from a referring physician. In addition, she
billed for services purportedly provided to deceased beneficiaries.
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In Michigan, pursuant to his guilty plea, a certified social worker
(CSW) was sentenced to 100 hours of community service and ordered to
pay $356,000 in restitution for health care fraud. Investigation revealed
that the CSW billed Medicare and a private insurer for psychotherapy
services that were never rendered.
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Kickbacks
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May 2006
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In Florida, a woman was ordered to pay $17,000 in restitution
for her involvement in a kickback scheme. The woman paid kickbacks
to an assisted living facility owner in exchange for allowing companies
that she represented to provide services to the residents at the
facility. Investigation revealed that the services that were being
provided were billed as physical and occupation therapy however,
the sessions typically only involved the therapists massaging and
applying lotion to the beneficiaries’ shoulders. In addition,
the woman paid kickbacks related to providing medically unnecessary
medical equipment to residents.
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Transportation
Fraud |
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May 2006 |
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In North Carolina, an ambulance company and its owner were sentenced
related to billing Medicare and Medicaid for dialysis patient transports
that were not medically necessary. The owner was sentenced to 120
months in jail for health care fraud and to an additional 31 months
in jail (to be run consecutively) for obstruction. The company and
the owner were also ordered to pay $604,000 in joint and several
restitution. Investigation revealed that emergency medical technicians
were instructed to enter false information on ambulance reports falsely
indicating patients required an ambulance when, in fact, they did
not and could have been transported by other means. The owner also
instructed billing personnel to submit claims indicating that patients
were bed-confined when, in fact, they were not bed-confined. In addition,
prior to an audit, the owner and the billing manager changed records
to indicate medical necessity. The owner also intentionally withheld
subpoenaed documents. The billing manager was previously sentenced
and was ordered to pay $30,000, a portion of the joint and several
restitution amount.
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