Child Support Enforcement

April 2003

In New Jersey, a man was sentenced to 6 months home confinement, 5 years probation and ordered to pay $69,000 in restitution for failure to pay child support. In addition, as conditions of his probation, the man must complete a drug treatment program, receive mental health counseling and obtain full-time employment. The man owed over $63,000 in overdue support for his two children and for a third child who is no longer living; he was a licensed pharmacist who earned over $50,000 a year.

In New Jersey, a man was sentenced to 2 months home confinement, 5 years probation and ordered to pay $52,000 in restitution for failure to pay child support.

In Iowa, a man was sentenced to 6 months home confinement with electronic monitoring and ordered to pay $43,000 in restitution for failure to pay child support.

In Ohio, a man was sentenced to 6 months in jail, 4 years supervised probation and ordered to pay $29,000 in restitution for failure to pay child support. The man worked in various positions in the retail industry and was a truck driver. Once he left the state, he never made a voluntary payment; he routinely quit jobs after wage garnishments were in place.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $10,000 in restitution for failure to pay child support. He was also ordered to remain current with his ongoing support obligation.

In Virginia, a man was sentenced to 1 year supervised probation and ordered to pay his remaining restitution amount of $2,000 for failure to pay child support. The man previously paid over $31,000 toward his arrearage to the Virginia Division of Child Support Enforcement. The man, who was once a professional basketball player, failed to pay support for his daughter since September 2000; he earned over $685,000 between 1999 and 2002.

Durable Medical Equipment

April 2003

In Florida, a woman was sentenced to 51 months in prison and ordered to pay $2.6 million in restitution for conspiracy and submitting false claims. The woman initially worked for a man who owned and controlled several DME companies. With his authorization and support, the woman opened her own DME company and hired a group of sales representatives to further expand company sales, and subsequently, submit false claims to the Medicare and Medicaid programs. In another Florida case, a DME sales representative was sentenced in April and ordered to pay $237,000 in restitution for conspiracy and submitting false claims to Medicare. The sales representative received and distributed commission payments to representatives working under his direction in exchange for fraudulent DME claims. He was also responsible for submitting a DME claim for a motorized wheelchair and positioning pad for a beneficiary that could walk unassisted.

In Texas, a shoe salesperson was sentenced to 46 months in prison and ordered to pay $1.4 million for health care fraud. While working for a shoe company, the salesperson, who specialized in selling custom made shoes for diabetic patients, received a 20 percent commission of all Medicare payments. The salesperson was responsible for preparing all paperwork connected with selling the shoes including obtaining physicians’ signatures on certificates of medical necessity (CMNs). The investigation revealed that she routinely forged the names of physicians on CMNs, resulting in fraudulent Medicare payments to the shoe company, which consequently allowed her to receive the commissions.

In California, a man was sentenced to 12 months in prison for health care fraud. The man and his co-conspirators billed Medicare for over $4 million worth of durable medical equipment that was either never provided or provided without a valid prescription from a physician.

Hospitals, Laboratories, and Clinics

April 2003

In Maine, a man was sentenced to 1 year and 1 day in prison and ordered to pay $274,000 in restitution and fines for causing a false cost report and a false tax return. The man, who created a physician group to provide services at a hospital where he served as chairman of the board, failed to disclose his consulting agreement, whereby his company paid him $350,000 a year that resulted in the hospital’s failure to include services as a “related party” on its Medicare and Medicaid cost reports from 1994 through 1997. In addition, the man failed to disclose his consulting fees on his personal 1995 through 1997 income tax returns.

In Connecticut, a former vice president of operations at a lab was ordered to pay a $1,000 fine for engaging in a conspiracy to obstruct a federal audit, obstructing a federal audit and submitting false statements to Medicare. Although the man worked in the lab’s New York office, he supervised the operations division in the Connecticut office. The man instructed employees at the lab to represent to Medicare auditors that technicians were performing transtelephonic monitoring tests in accordance with Medicare guidelines, when in fact he knew they were not.

Kickbacks

April 2003

In Florida, a woman was sentenced to 60 months imprisonment, 3 years supervised release and ordered to pay $5.3 million in restitution for conspiracy to commit fraud, and for paying and receiving illegal remunerations or kickbacks. The woman and seven co-conspirators were convicted in July 2002.

In Montana, a former Indian Health Service (IHS) employee was sentenced to 12 months and 1 day in prison and ordered to pay $24,000 in restitution for fraud. Also, a former accounting technician for the Bureau of Indian Affairs (BIA) was sentenced to 3 years supervised probation for unlawful acceptance of gratuities. The former IHS employee accepted kickback payments in excess of $12,500 for purchasing unnecessary and over-priced electrical supplies. As part of the scheme, the IHS employee split government credit card purchases to avoid the individual credit card daily purchase limit. The former BIA employee received in excess of $3,000 from a co-conspirator who co-owned a heating and cooling company, in return for preferential treatment as a government contractor. The company performed heating, ventilation and cooling services for both the BIA and the IHS.

Misuse of Grant Funds

April 2003

In South Dakota, a woman was ordered to pay $4,000 in restitution for embezzlement and theft from an Indian Tribe and an Indian Tribal Organization. From April 2000 through June 2001, as the director of a tribal childcare program, the woman embezzled program funds by submitting false travel vouchers.

Physicians and Other Health Care Professionals

April 2003

In Wyoming, a pharmacist was ordered to pay $140,000 in restitution and fines for obtaining property by false pretenses. The pharmacist failed to maintain proper documentation for his Medicaid billings and billed Medicaid for brand name prescriptions but actually only provided generic medications.

A Pennsylvania podiatrist was ordered to pay $12,000 in restitution and fines for hiding a felony crime. The podiatrist received Medicare payments for fraudulent health care insurance claims submitted by a doctor’s office for patients that the podiatrist had not seen. He then concealed and failed to make known the misconduct to a judge or other person in civil authority. Although he initially claimed that he had seen the patients, the podiatrist later admitted that he had not seen the patients and fabricated notes to support his assertion.

In Ohio, a registered nurse (RN) was sentenced to 5 years and 2 months in prison and ordered to pay $1,000 in fines and court costs. After a four-day jury trial, the woman was found guilty on 11 of 15 felony counts of theft of drugs. As a registered nurse at a medical center, the woman stole various types of narcotics for her own use. She altered patient charts and other records in an attempt to conceal her crimes. Many of the drugs that the RN diverted never reached the seriously ill patients for whom they were prescribed. The RN’s nursing license had been suspended in another state for similar misconduct.

Prescription Drug Fraud

April 2003

An Indiana woman was sentenced to 10 years in jail with 5 years suspended, if she complies with all conditions of a 5-year probationary period, for dealing a Schedule II controlled substance. The investigation revolved around a physician who prescribed large quantities of OxyContin to a Medicaid recipient. The Medicaid recipient in turn diverted the prescription drugs to the woman and other individuals.

In Ohio, a woman was sentenced to 360 days confinement for Medicaid fraud. The woman fraudulently used her mother’s identity and Medicaid number to obtain prescription drugs.

In Washington, D.C., a woman was sentenced for her involvement in a drug diversion scheme. The woman was part of a group of individuals, which included doctors, pharmacists and other health care professionals, who were involved in various schemes to divert prescription drugs while defrauding Medicaid, Medicare and private insurance programs.

Other Cases of Interest

April 2003

In Maryland, a man was sentenced to 24 months incarceration and ordered to pay $76,000 in restitution for conspiracy to commit fraud with identity theft. The man was ordered to pay the restitution amount jointly and severally with a co-conspirator. The co-conspirator, a former Department of Health and Human Services (HHS) file room clerk, conspired with the man to assume the identities of numerous HHS employees and use that personal information to apply for and obtain credit at various merchants.

In West Virginia, a woman was sentenced to 27 months incarceration and ordered to pay $47,000 in restitution for mail fraud and social security fraud. From approximately July 1997 until July 2002, the woman used multiple aliases to obtain money from the workers’ compensation program. In addition, she used a false name and social security number to obtain medical assistance and food stamps.

In Maine, a man was sentenced to 6 months in prison and ordered to pay $25,000 in restitution for theft/embezzlement in connection with health care fraud. Through his position as a billing consultant and temporary employee for a number of health care providers, he was able to steal and embezzle funds.

In Virginia, a man was sentenced for threatening and retaliating against a federal witness. The man threatened to kill a federal witness who notified authorities and testified in criminal proceedings regarding charges against his wife. The man’s wife was sentenced for conspiracy, Medicaid and Social Security fraud, and other benefit program related charges.