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Durable
Medical Equipment
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| June 2004 |
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In Texas, a man was sentenced to 13 months incarceration and ordered to pay $105,000 in restitution
for health care fraud. Through his company, the man billed Medicare for power wheelchairs using a
code that did not correspond to the wheelchair that was actually provided.
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Physicians
and Other Health Care Professionals
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| June 2004 |
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A Virginia physician was sentenced to 18 months incarceration and ordered to pay a $10,000 fine
and $191,000 in restitution for health care fraud. From approximately January 2000 through October
2003, the physician submitted upcoded claims to Medicare and to a private insurer. In addition,
claims submitted reflected comprehensive office visits that did not occur at all, or were for dates
of service when the patient was only provided a prescription refill. The investigation began in
July 2003 when the private insurer found that the physician’s billings were much higher than
the average medical provider in the area. Shortly after the investigation began, a fire occurred
at the physician’s medical office, which was determined to be a case of arson. Although a
grand jury returned an indictment charging the physician with arson in connection with the fire,
the Government dismissed the charge in exchange for his guilty plea to health care fraud.
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Child
Support Enforcement
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June 2004
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In Maryland, a former U.S. professional basketball player was sentenced to 12 months and 1 day
in prison, 12 months supervised release and ordered to pay $128,000 in restitution for failure
to pay child support. The sentencing was the culmination of a 5-year Office of Inspector General
(OIG) investigation during which the man was located in Spain and proof of his sizeable professional
earnings in three foreign ball clubs was obtained through the OIG’s first-ever use of a Mutual
Legal Assistance Treaty, an international agreement to facilitate judicial assistance. Through
this process, the U.S. State Department and Spain’s Department of Justice were able to establish
that the man had the ability to support a son during the same years in which he benefited from
declaring the boy as a dependent on his income taxes.
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In Louisiana, a man was sentenced to 2 years probation and ordered to pay a $2,500 fine for
failure to pay child support. Prior to sentencing, he paid $64,750, representing 11 years of overdue
arrearage,
and also paid all future support payments due from the present through his daughter’s age
of majority. In 2002, the man was operating a successful business with a taxable annual income
of $184,000. In 2003, he earned a greater amount and owned two high-end sport utility vehicles,
while his ex-wife and daughter lived in Government subsidized housing.
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Employee
Misconduct
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June 2004
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In New Mexico, an Indian Health Service (IHS) contract employee was sentenced to 3 years supervised
release and ordered to pay $26,000 in restitution for embezzlement. The man, who was supervising
a construction project for IHS, embezzled money in order to add an addition to his home.
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