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Hospitals,
Laboratories, and Clinics
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| February 2004 |
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In South Carolina, the remaining five physicians from a pain management center were sentenced
for their roles in defrauding the Government. They were the last of ten individuals sentenced in
a case that resulted in over 70 years total incarceration and ordered restitution totaling approximately
$811,000. The doctors at the center prescribed controlled substances outside the usual course of
medical practice and forced unnecessary tests on patients in order to submit fraudulent claims to
Medicare and other health care plans. Narcotics were provided to patients after little or no physical
exam, and doctors met with more than one patient at a time in an effort to increase the clinic’s
revenue.
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Durable
Medical Equipment
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| February 2004 |
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In South Carolina, an owner/operator of a DME company was sentenced to 5 months in prison and
ordered to pay $88,000 in restitution for health care fraud. From February 1998 through 2002, the
woman submitted claims for repairs to wheelchairs and mechanical hospital beds that were never performed.
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Physicians
and Other Health Care Professionals
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| February 2004 |
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In New York, a man was sentenced to 24 months incarceration and ordered to pay $398,000 in restitution
for health care fraud. Although he possessed a valid license as a clinical psychologist in Massachusetts,
the man did not meet the criteria for licensure in New York but purported to be licensed in the
State. Based on the Massachusetts license, he was able to obtain Medicare and private provider
numbers. The man used these numbers to submit claims to Medicare that were upcoded, not rendered,
or for telephonic services. For his private pay patients, he submitted claims as if the patients
were treated in Massachusetts.
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Medicaid
Fraud
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February 2004
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In Virginia, two operators of a cab service were sentenced to 27 months and 21 months in prison,
respectively, for submitting claims to Medicaid for taxi services they did not provide. They were
also ordered to pay $395,000 in joint and several restitution.
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