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Durable
Medical Equipment
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| February 2006 |
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In Texas, the owner of a durable medical equipment (DME) company was sentenced to 63 months
in prison and ordered to pay $669,000 in restitution for conspiracy and health care fraud.
The man fraudulently billed Medicare for motorized wheelchairs and accessories, and alternating
pressure mattresses. Beneficiaries either did not receive any equipment at all or were provided
with a less expensive item. In addition, the man paid recruiters between $200 and $500 for
beneficiary’s personal information.
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Practitioners
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February 2006
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In Ohio, a podiatrist was sentenced to 78 months incarceration and ordered to pay $528,000
in restitution for conspiracy, health care fraud, and false statements. The podiatrist, after
being reinstated to the Medicare program in 2002, billed Medicare for non-covered routine foot
care. Patient charts contained no documentation other than the handwritten date of service.
In 2000, the Department of Justice recommended that the podiatrist be excluded for failure
to repay his Health Educational Assistance Loan. In order to avoid the exclusion, the podiatrist
submitted a fraudulent provider application to Medicare listing the owner of his new company
as his dying friend, who was also a podiatrist, and began billing under the false identity.
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In Virginia, a podiatrist was sentenced to one year and one day in prison for mail fraud. The
podiatrist billed for procedures performed at a surgery center when, in fact, the services
performed were routine, and performed in the office. The address of the surgery center was
actually a mailbox rental business located next to his office. Through his billing scheme,
the podiatrist was reimbursed for facility-related charges such as pre-op and post-op rooms.
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Child
Support Enforcement
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February 2006
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In Florida, a man was sentenced to 5 years probation and ordered
to pay $47,000 in restitution for failure to pay child support. The
man, who was ordered to pay support in 1987, gave numerous reasons
for not making his support payments, including that he felt the custodial
parent was capable of supporting herself and their minor child. The
man’s last documented support payment was involuntary and occurred
in May 1990. The investigation revealed that the man had changed
his last name, and lived in at least four different States after
leaving Florida.
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Home
Health Agencies |
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February
2006 |
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In Tennessee, a man who owned a home health agency (HHA) serving
Medicare beneficiaries and an agency providing private duty nursing
services to non-Medicare beneficiaries was sentenced to 24 months
incarceration, part of which will be spent in a half-way house, and
ordered to pay a $700 assessment for health care fraud and false
statements. A decision on the amount of restitution the man must
pay has been deferred. The investigation revealed that the man failed
to disclose his nursing service agency as a related party on his
HHA’s cost reports for years 1998, 1999 and 2000. In addition,
costs for nursing services for non-Medicare beneficiaries were shifted
to the HHA’s Medicare cost reports.
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