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Criminal and Civil Enforcement

February 2003 Criminal Enforcement Report

Physicians and Other Health Care Professionals

As a result of a plea agreement, an individual practitioner in Indiana was sentenced to 21 months in prison and ordered to pay over $1.9 million to specifically named entities who suffered injuries due to his role in a scheme to defraud insurance carriers and cancer patients. With the help of his officer manager, the practitioner, who operated a medical center, aggressively marketed the center to terminally ill cancer patients. The treatments offered at the center included drugs not approved by the Food and Drug Administration. These treatments were billed as if the patients were receiving chemotherapy. Patients were accepted to the center based on their ability to pay rather than their condition and often had to make a cash payment to enter the program. In addition, the practitioner received kickbacks from a medical supply company for referring Medicare patients to them.

A Michigan podiatrist, who had been found guilty on two counts of health care fraud and two counts of mail fraud, was sentenced to 51 months confinement for each count to be served concurrently and ordered to pay $983,000 in restitution.

A North Carolina individual practitioner was sentenced to 21 months imprisonment and ordered to pay $493,000 in restitution for obstruction of criminal investigations of health care offenses.

In New York, an individual practitioner was ordered to pay a $30,000 fine for violating the anti-kickback statute. The doctor received kickback payments from a medical supply company, a MRI center and a lab.

In Georgia, a physician was sentenced to 41 months confinement for unlawful dispensation of a controlled substance and false claims. As owner of a family practice, he distributed OxyContin and other Schedule II narcotics to Medicaid, privately insured, and cash paying patients without a medical reason. In addition, the physician was reportedly taking various controlled substances while treating Medicare and Medicaid patients.

Home Health Agencies

In Missouri, six co-defendants were sentenced for conspiring to defraud the United States through a system of kickbacks for patient referrals and the filing of false claims that resulted in overpayments from Medicare and Medicaid. The individuals sentenced included a licensed medical doctor, a registered nurse, a billing service owner, an employee who provided medical billing services, and two owners of several residential care facilities and HHAs. The six were ordered to pay respective restitution amounts totaling $526,000; and four were sentenced to prison. One central aspect of the scheme involved the owners' referral of patients from their residential facilities to doctors in exchange for them to certify the patients as homebound and eligible for their home health services. This arrangement allowed the doctors to bill Medicare and Medicaid for patient visits and the HHAs to bill Medicare and Medicaid for providing home health services.

Ambulance Companies

The owner of two ambulance companies in Texas was sentenced to 24 months imprisonment and ordered to pay $260,000 in restitution for wire fraud and health care fraud. The owner billed Medicare for ambulance runs that were not provided. In addition, she continued to bill Medicare for services after the companies had closed for business.

An ambulance company owner in Pennsylvania was sentenced to 15 months imprisonment and ordered to pay $30,000 in restitution for mail fraud and failure to file a tax return. Because of a fraud conviction, the owner was previously excluded from Medicare and Medicaid. As a result, he used a “straw party” to start two ambulance companies and billed Medicare and Medicaid for transports that were non-compensable or medically unnecessary; he also failed to file tax returns.

Misuse of Grant Funds

A contract bookkeeper for an agency receiving DHHS grant funds was sentenced to 18 months incarceration and ordered to pay $216,000 in restitution for embezzlement and tax evasion. The grant funds were to be used for providing aging services for Native American tribes in Montana. The bookkeeper embezzled funds by issuing unauthorized payments; she either pre-signed checks or forged authorizing signatures on checks. In addition, she created a fraudulent work contract and submitted claims for contract work that was never performed; she also failed to file income tax returns during the time of embezzlement.

Durable Medical Equipment

In Florida, a DME company owner was ordered to pay $206,000 in restitution for false claims and conspiracy to defraud the government. The owner submitted fraudulent claims for therapeutic ventilators, urological supplies and suction pumps.

In Florida, a salesperson for a DME company was ordered to pay $59,000 in restitution for false claims. The salesperson initiated DME claims for two fictitious Medicare beneficiaries.

A California durable medical equipment company owner was sentenced to 12 months in prison and ordered to pay $38,000 in restitution for health care fraud and money laundering. The owner instructed a medical clinic to refer business to his company in exchange for a percentage of his net profit. In addition, the owner repeatedly instructed the clinic to change medical diagnoses on Medicare claims and to add medically unnecessary items to orders. The owner used the proceeds from the fraud to pay the clinic for the referrals.

Psychiatric Services

In West Virginia, the president and vice president of a counseling center were sentenced. The president was sentenced to 1 year and 1 day in prison and ordered to pay $175,000 in restitution for mail fraud and theft of federal funds; and the vice president was ordered to pay $4,000 in restitution for mail fraud. The two defendants contracted physicians to provide psychiatric services only on scheduled Saturdays but submitted claim forms that were pre-signed by the physicians for services rendered on weekdays. In addition, pre-signed claim forms submitted to Medicare and Medicaid indicated a licensed psychiatrist rendered the service when, in fact, a licensed psychiatrist did not provided the service. The president was also involved in a scheme that embezzled funds from four federally subsidized housing projects. While managing the housing complexes, she filed invoices to the U.S. Department of Housing and Urban Development for work that was never done.

Prescription Drug Fraud

An Indiana physician was sentenced to 51 months incarceration and ordered to pay $29,000 in restitution for health care fraud, dispensing a controlled substance and possession with intent to distribute a controlled substance. The physician prescribed OxyContin to a Medicaid recipient outside the scope of professional practice and without a legitimate medical purpose. The investigation revealed that the physician was the highest prescriber of OxyContin in the state, prescribing five times more OxyContin than the next highest physician.

In Pennsylvania, three individuals were sentenced for their involvement in a scheme that led to the distribution of large quantities of prescription drugs. A pharmacy owner was sentenced to 54 months incarceration and ordered to pay $9,000 in fines and assessments; the two other individuals were sentenced, one of them to 30 months incarceration and the other to 6 months incarceration. As the owner of a small independent neighborhood pharmacy, the pharmacist was involved in multiple conspiracies including using physicians' names and Drug Enforcement Administration numbers without legal authorization to create false hard copy prescriptions in order to cover up his illegal drug distribution. In addition, the pharmacist conspired with others who brought items to the pharmacy such as televisions, DVD and CD players in exchange for controlled substances.

In Pennsylvania, an individual was sentenced to 7 months imprisonment and ordered to pay $5,000 in restitution for acquiring a controlled substance by deception and health care fraud. During an 18-month period, using his wife's Federal Employee Health Benefits, the individual visited at least 67 physicians and 18 pharmacies in order to obtain OxyContin tablets.

In Maryland, an individual pled guilty to insurance fraud and was sentenced to 2 years supervised probation. The individual was visiting five different doctors to fraudulently obtained Schedule II narcotics. In less than two years, one doctor wrote over 110 prescriptions for the individual. The prescriptions were written in her husband's name and filled using her husband's health insurance plan.

Mental and Social Services

A community mental health center (CMHC) therapist in Texas was sentenced for mail fraud; the employee paid $19,000 in restitution at sentencing. As a licensed occupational therapist, the employee caused the mailing of 45 fraudulent claims to Medicare. The administrator at the CMHC convinced the therapist to prepare and sign backdated occupational therapy assessments to support the fraudulent claims.

Child Support Enforcement

In Florida, a man was sentenced to 5 years probation and ordered to pay $92,000 in restitution for failure to pay child support. Since March 1994, he failed to pay support for his son. In an attempt to evade paying, he held at least five different jobs while living in Tennessee.

In Iowa, a man was sentenced to 27 months incarceration, with 12 months deducted for time served in connection with a state conviction, 1 year supervised release and ordered to pay $87,000 in restitution for failure to pay child support. The judge ordered that the man be detained and immediately turned over to the Bureau of Prisons to begin serving his sentence.

In Michigan, a man pled guilty to failure to pay child support and will be required to complete a 3-year probationary term and repay all past due support pursuant to a payment plan to be determined by the court. The man currently owes almost $79,000 in overdue support for his two daughters.

In Washington, D.C., a man was sentenced to 90 days incarceration, 5 years probation and ordered to pay $77,000 in restitution for failure to pay child support. In 1989, the man was ordered to pay $700 a month in support of his three children. As a computer consultant, he usually earned between $45 and $50 an hour; in 2000, his annual income exceeded $76,000. Most support payments received were a result of wage garnishments which have been difficult to maintain since the man often works for several companies during a year.

In Ohio, a man was sentenced to 6 months electronic monitoring, 5 years probation and ordered to pay $71,000 in restitution for failure to pay child support. In 1984, the man was ordered to pay $818 a month for his three children. From August 1998 through August 2000, he earned $60,000 but only made one $20 payment.

In Iowa, a man was sentenced to 6 months home confinement with electronic monitoring, 3 years probation and ordered to pay $56,000 in restitution for failure to pay child support.

In New York, a man was sentenced to 3 months time served, 5 years probation and ordered to pay $44,000 in restitution for failure to pay child support. In addition, he must maintain his current monthly support obligation of $350. In July 2002, the man was arrested and was remanded into custody after being deemed a flight risk by the court. In September 2002, he pled guilty and was released on bail; he was in the United States Marshal's Service custody for 3 months.

In Ohio, a man was sentenced to 17 months in prison, 5 years supervised probation and ordered to pay $30,000 in restitution and pay a $500 fine for failure to pay child support. The man also owes $22,000 in overdue support in an unrelated case in New York. In addition, another of the man's children became a ward of the state since neither he nor the mother supported the child. The man worked in various positions in the retail industry and frequently moved and changed jobs in order to avoid wage garnishments.

In Ohio, a man was sentenced to 8 months in prison and ordered to pay $25,000 in restitution for failure to pay child support. Although working in Florida as a mechanic, he never made a voluntary payment.

In Arkansas, a man pled guilty and was sentenced to 5 years probation and ordered to pay $24,000 in restitution for failure to pay child support. Although the man was ordered in 1987 to pay support, he never made any payments.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $21,000 in restitution for failure to pay child support. The man was ordered to pay support for his two children in 1998.

In Virginia, a man was sentenced to 5 years probation and ordered to pay $17,000 in restitution for failure to pay child support. Although ordered to pay $65 a week, the man only made three involuntary payments during the period July 1998 through December 2002.

Other Cases of Interest

In Wisconsin, a man was sentenced to 84 months imprisonment and ordered to pay $233,000 in restitution for his scheme to defraud the government. The man assumed several false identities and applied for and received Social Security retirement benefits using the false identities. In addition, using a false identity and Social Security number, he obtained contract employment.

In New York, a woman was sentenced to 15 months incarceration and ordered to pay $96,000 in restitution for her involvement in stealing, altering and distributing private health insurance checks, Medicare checks and United States Treasury checks.

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March 2003 Criminal Enforcement Report

Ambulance Companies

In Illinois, a former owner of an ambulance service was sentenced to 27 months imprisonment and ordered to pay $600,000 in restitution for health care fraud. The man submitted claims for transports that were medically unnecessary. In addition, ambulance run records were altered to add services that were not provided to patients.

Child Support Enforcement

In Arizona, a man was sentenced to 16 months in prison and ordered to pay $157,000 in restitution for failure to pay child support. The man is the author of a book that teaches techniques on how to appear poor or disappear completely and resurface under a new identity. The man used his own vanishing techniques for over 9 years and eluded paying his support obligation by hiding under assumed names, laundering money through family members and business associates, and by failing to pay income tax.

In Florida, a man was sentenced to 5 years probation and ordered to pay $120,000 in restitution for failure to pay child support obligation since July 1994. The man received more than $75,000 in workman's compensation benefits from July 1994 through July 1997.

In Michigan, an orthopedic surgeon was sentenced to 30 days incarceration, 2 years probation and ordered to pay $61,000 in restitution for failure to pay child support. The restitution amount was paid at sentencing. The man, who falsified his financial affidavit to the court, was also ordered to pay fees submitted by the public defender.

In Illinois, a man was sentenced to 6 months incarceration and ordered to pay $47,000 in restitution for failure to pay child support. Although steadily employed while living in Missouri, the man never made a payment for his child who is now approaching 18 years old.

In Florida, a man was sentenced to 5 years probation and ordered to pay $39,000 in restitution for failure to pay child support. As part of a plea agreement, the man paid $5,000 at sentencing and was ordered to participate in a drug and alcohol rehabilitation program and to maintain employment.

In Ohio, a man was sentenced to 3 years supervised probation, 200 hours of community service and was ordered to pay $35,000 in restitution and a $500 fine for failure to pay child support. The man, who earned a moderate income, never made a voluntary support payment.

In Virginia, a man was sentenced to 6 months incarceration, 1 year supervised probation and ordered to pay $32,000 in restitution for failure to pay child support. The man, who was unemployed, received disability checks from the Social Security Administration. During the investigation, it was revealed that he filed for Chapter 13 bankruptcy.

In Wyoming, a man was sentenced to 5 years supervised probation and ordered to pay $24,000 in restitution for failure to pay child support. In July 2002, an arrest warrant was issued, and as a result, the man self-surrendered to agents in Missouri.

In Wyoming, a man was sentenced to 5 years probation and ordered to pay $22,000 in restitution for failure to pay child support.

In South Dakota, based on his guilty plea, a man was sentenced to 5 years supervised probation and ordered to pay $14,000 in restitution for failure to pay court-ordered child support.

In Wyoming, a man arrested in July 2002 was sentenced to 5 years probation and ordered to pay $11,000 in restitution for failure to pay child support.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $9,000 in restitution for failure to pay child support. He was also ordered to participate in a community corrections residential facility for at least 90 days.

In Arkansas, a man was sentenced to 5 years probation and ordered to pay $9,000 in restitution for failure to pay child support. The man, who never made a payment, frequently changed jobs in order to avoid paying his obligation.

Durable Medical Equipment

In Florida, a man in control of several durable medical equipment (DME) corporations was sentenced to 84 months in prison and ordered to pay $14.4 million in restitution for his role in schemes to defraud Medicare and Medicaid. In addition, the court ordered a $14.8 million order of forfeiture against him. The man previously pled guilty on behalf of six DME corporations that were set up to launder money. Despite a temporary restraining order, the man and his co-conspirators continued to fraudulently bill Medicare and launder the proceeds of the fraud through offshore bank accounts.

In addition, a co-conspirator was sentenced to 1 year and 1 day in prison and ordered to pay $474,000 in restitution for conspiracy and submitting false claims. The sales representative received commissions from the sale of motorized wheelchairs, alternating pressure mattresses and related items. Another sales representative was ordered to pay $485,000 in restitution for conspiracy and submitting false claims to Medicare and Medicaid. The man received and distributed commission payments for other sales representatives working under his direction.

A New York couple who owned a durable medical equipment company were sentenced based on their guilt pleas. The husband was sentenced to 15 months incarceration and ordered to pay $210,000 in restitution for health care fraud. His wife was sentenced to 6 months in a halfway house and 6 months home detention for paying kickbacks to doctors. Although the owners and their staff provided Medicare and Medicaid beneficiaries with inexpensive soft back braces, they actually billed Medicare for expensive, firm body jackets. The wife provided the funding that was used to pay kickbacks to doctors for their referrals and prescriptions.

Employee Misconduct

In Maryland, a former National Institutes of Health employee was ordered to pay $17,000 in restitution for conspiracy to use unauthorized access devices.

Kickbacks

In Massachusetts, a physician was ordered to pay a $5,000 fine for conspiring to receive kickbacks from a pharmaceutical company. The physician conspired with a sales representative from the company to receive free samples of the prostate cancer drug, Lupron Depot, in return for his decision to switch his patients from another drug to Lupron. The physician, who received 30 free samples, not only switched patients to the drug, but also billed Medicare for the free samples.

In Montana, three people were sentenced for their involvement in defrauding the Indian Health Service (IHS) regarding the purchase of electrical supplies. An independent electrical supply salesman was sentenced to 60 months in prison and ordered to pay $18,000 in restitution. Former HIS employees were sentenced; one was sentenced to 12 months and 1 day in prison and ordered to pay $11,000 in restitution and the other was sentenced to 3 months home confinement and ordered to pay $1,000 in restitution. The salesman paid kickbacks to IHS employees in the form of cash, gifts and weapons for purchasing over-priced electrical supplies, most of which were unnecessary. In addition, to avoid the $2,500 individual government credit card purchase limit, orders for the electrical supplies were split.

Mental and Social Services

Two owners of a community mental health clinic in Texas were convicted for submitting fraudulent Medicare cost reports for years 1995 through 1998. One defendant was sentenced to 60 months incarceration and the other defendant was sentenced to 96 months incarceration. They were ordered to make joint restitution in the amount of $2.8 million.

Physicians and Other Health Care Professionals

A Pennsylvania podiatrist was sentenced to 12 months and 1 day imprisonment and ordered to pay $409,000 in fines and restitution. The podiatrist previously pled guilty to false statements relating to health care matters. During a 6-year period, the podiatrist billed Medicare for more than 20,000 nail avulsion surgical procedures when in fact the number was significantly lower.

In Illinois, a pharmacist was sentenced to 6 months incarceration and ordered to make restitution of $292,000 to three private insurance companies for providing false information related to her financial condition in settlement of a qui tam lawsuit. In May 2002, the pharmacist admitted that she was involved with a fire at her residence, resulting in her financial gain. The pharmacist was previously convicted and sentenced for defrauding Medicaid for submitting improper claims for pharmacy related services that were never rendered. Subsequent to her criminal conviction, she entered into a civil settlement with the government to resolve her civil liability in a qui tam lawsuit for the same misconduct; it was later revealed that she provided false information regarding her financial condition.

A New York physician was sentenced to 6 months imprisonment and ordered to pay $250,000 in restitution for health care fraud. The owner of a clinic billed Medicare using the physician's Medicare provider number. In return for the use of his provider number, the owner of the clinic paid the physician $2,500 a month and let him utilize office space and billing staff at the clinic. As a result, the owner received payments from Medicare for physical therapy services he was not qualified or legally allowed to perform and for services that were not provided.

Prescription Drug Fraud

In Illinois, a woman was ordered to pay $122,000 in restitution for health care fraud. The woman, along with others, conspired to steal the growth hormone, Serotim, from an AIDS clinic. The drug was then illegally distributed to individuals at body building gyms.

In Ohio, a doctor and two Medicaid recipients were sentenced for their role in an OxyContin distribution conspiracy. The doctor was sentenced to 8 years and 1 month in prison and ordered to pay a $15,000 fine for conspiracy to distribute a controlled substance. The doctor's plea stemmed from a 49-count indictment charging him with various offenses including health care fraud and drug trafficking. The doctor initiated, organized and operated one of the largest, physician-directed, OxyContin distribution conspiracies in the United States. One of the Medicaid recipients was sentenced to 3 years supervised probation with 6 months electronic monitoring and the other was sentenced to 1 year in prison and ordered to pay a $500 fine.

Other Cases of Interest

In Pennsylvania, the owner of a billing service was ordered to pay $12,000 in restitution for making a false statement of material fact in an application for a benefit or payment under the Medicare program. The man was hired by the executor of a deceased physician's estate to complete billings for services and was paid between 25 and 33 percent for anything he collected from Medicare. As a result, the man upcoded claims, unbundled claims and billed for services that had already been paid. He also billed for dates of service that occurred after the physician's date of death.

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April 2003 Criminal Enforcement Report

Child Support Enforcement

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

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

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

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

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

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

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

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.

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May 2003 Criminal Enforcement Report

Child Support Enforcement

In Delaware, a man was sentenced to 4 years probation and ordered to pay $164,000 in restitution for failure to pay child support. In addition, he was ordered to maintain employment.

In Nevada, a man was sentenced to 1 year probation and ordered to pay $60,000 in restitution for failure to pay child support. In addition, the man was ordered to remain current on future child support payments

In Iowa, a man was sentenced to 4 months home confinement, 5 years probation and ordered to pay $35,000 in restitution for failure to pay child support. The man, who owed almost $45,000 in overdue support, paid $10,000 prior to sentencing.

In Arkansas, a man was sentenced to 5 years probation and ordered to pay $26,000 in restitution for failure to pay child support. The man has been employed as an electrician while living in Alabama.

In Wyoming, a man was sentenced to 5 years supervised probation and ordered to pay $15,000 in restitution for failure to pay child support. A certified public accountant, he was arrested in July 2002 in Colorado.

In South Dakota, a man was sentenced to 6 months home detention, 5 years supervised probation and ordered to pay $13,000 in restitution for failure to pay child support. The man has paid $5,000 since his arrest in November 2002.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $2,000 in restitution for failure to pay child support. Since his arrest in December 2002, the man has paid over $10,000 toward his arrearage amount.

In Indiana, a man was sentenced to 5 years probation and ordered to pay $49,000 in restitution for failure to pay child support. the man had not made a support payment in 5 years for his four sons. He was a former general manager of two professional indoor football teams.

Durable Medical Equipment

In Georgia, two subjects were sentenced to serve time incarcerated and were ordered to pay restitution for their role in a scheme to defraud Medicare. From 1997 through 2002, they submitted numerous false claims to Medicare for motorized wheelchairs that were never provided to beneficiaries.

Kickbacks

In New York, the owner of a medical lab was sentenced to 24 months incarceration and ordered to pay $284,000 in restitution for conspiracy to commit health care fraud. The owner instructed his sales representatives to pay kickbacks to doctors in return for the referral of patient specimens. In an attempt to conceal the kickbacks, the owner established shell companies for each of the sales representatives. The owner deposited money into these accounts so that the sales representatives could withdraw money and then provide cash payments to the doctors.

Misuse of Grant Funds

In West Virginia, a woman was sentenced to 42 months incarceration and ordered to pay $302,000 in restitution for mail fraud. While employed by the West Virginia Department of Health and Human Resources, the woman embezzled more than $302,000, most of which came from Temporary Assistance for Needy Families grants.

In West Virginia, a woman was sentenced to 5 months imprisonment and ordered to pay over $40,000 in restitution for theft from an organization that received federal funds. As a payroll specialist for a HHS grantee, she embezzled approximately $40,000 by writing herself checks from the Head Start account.

Physicians and Other Health Care Professionals

In New York, after entering a guilty plea, a psychiatrist was sentenced to a conditional discharge for his submission of false filings. The man agreed to repay $502,000 in restitution to Medicare and Medicaid for billing for office consultations and medication dispensing when no consultations actually took place.

In Wisconsin, a woman was sentenced to 33 months incarceration and ordered to pay $351,000 in restitution for health care fraud and violating the anti-kickback statute. The woman, who was previously excluded from Medicare and Medicaid due to a Medicaid fraud conviction, owned and operated staffing agencies that supplied temporary employees to nursing homes and other facilities with Medicaid and Medicare residents. The woman had a valid registered nurse's license despite her conviction and provided some of the services herself. In addition, she bribed the schedulers in at least two nursing homes in order to obtain business.

Following a guilty plea for health care fraud, a New York man, who claimed to be a doctor, was sentenced to 4 months in federal prison and ordered to pay $233,000 in restitution. The investigation revealed that as of 1981 the man only completed six semesters in a medical program at a University in Mexico. Although he never completed medical school, he received a state medical license in 1992 using altered academic transcripts and a fake diploma. The man allegedly bribed a medical school employee to obtain the transcript and diploma.

In California, a doctor was sentenced for health care fraud and was required to surrender his medical license for billing Medicare and private insurers for diagnostic studies that never occurred. The doctor may not reapply for a 5-year period.

Prescription Drug Fraud

In Florida, a man and his wife were sentenced for conspiracy to defraud. The man was sentenced to 60 months in prison and ordered to pay $4.9 million in restitution. His wife was sentenced to 60 months in prison and ordered to pay $4 million in restitution. The couple operated two pharmacies and participated in distributing sub-potent aerosol medication to patients. The pharmacies also sold pharmaceutical labels for medication and provided only half-portions of medications but billed Medicare for the entire amount. In another aspect of the case, a doctor was sentenced to 60 months in prison and ordered to pay $4.1 million in restitution for conspiracy to defraud. The doctor signed certificates of medical necessity and issued unnecessary prescriptions for aerosol medications for patients who were never examined. The doctor was paid $100 for each prescription by the operators of durable medical equipment companies.

In Washington, D.C., a man received a suspended sentence of 3 years incarceration for distribution of controlled substances. The case centered on a physician allegedly involved in various schemes to defraud the government and private insurance programs.

Other Cases of Interest

In Florida, a woman was ordered to pay a $4,000 fine for causing the submission of a false claim. The woman was employed by a company that provides computer related services to Medicare carriers. The computer related services enable Medicare carriers to receive, process, adjudicate and pay Medicare claims. The woman was directed to falsify time records of various computer programmers and analysts, which in turn caused fraudulent billings to Medicare.

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June 2003 Criminal Enforcement Report

Child Support Enforcement

In Ohio, a man was sentenced to 4 years probation and ordered to pay $54,000 in restitution for failure to pay child support for his three children. In July 2002, the Lorain County grand jury indicted the man, and he was later arrested in Maine. The man is currently serving an 18-month sentence as a result of his failure to abide by the terms of a 1992 conviction for failure to pay child support.

In Arkansas, a man was sentenced to 5 years probation and ordered to pay $41,000 in restitution for failure to pay child support. The man admitted that he had lived in at least 10 different states during the past 3 years in his attempt to avoid arrest.

In Puerto Rico, a man was sentenced to 5 years probation and ordered to pay $30,000 in restitution for failure to pay child support. The man attributed his failure to pay to an addiction to controlled substances.

In South Dakota, a man was sentenced to 10 months incarceration, 1 year supervised release and ordered to pay $23,000 in restitution for failure to pay child support. The man was indicted in October 2002 after failing to pay toward his obligation since 2000.

In Ohio, a man was sentenced to 5 years probation and ordered to pay almost $23,000 in restitution for failure to pay child support. In 1993, the man was ordered to pay approximately $300 a month for his two children. The man, who lives in Arizona, only made a few sporadic payments since 1998.

In South Dakota, a man was sentenced to 5 years supervised probation and ordered to pay $18,000 in restitution for failure to pay child support.

In South Dakota, a woman was sentenced to 6 months home confinement with 2 months electronic monitoring, 5 years supervised probation and ordered to pay $12,000 in restitution for failure to pay child support. The woman was indicted in August 2002 after failing to make any support payments since 1998.

Durable Medical Equipment

In Texas, a man was sentenced to 12 months and 1 day incarceration and ordered to pay $385,000 in restitution, jointly and severally with his wife. As owners and operators of a durable medical equipment (DME) company, the couple billed Medicare for DME that was never provided. In addition, the couple began billing Medicare through a different DME company after they realized that the company was being investigated.

In California, a man was sentenced to 24 months in prison and ordered to forfeit $856,000 in cash and a $735,000 house for health care fraud. The man along with 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.

Misuse of Grant Funds

In Michigan, a woman was sentenced to 2 years incarceration and ordered to pay $1 million in restitution for mail fraud. The woman fraudulently used grant funds provided by Temporary Assistance for Needy Families and the Child Care and Development Fund intended for operating day care facilities. During the investigation, it was determined that claims submitted were for the care of children that were not in the center at the time indicated.

Physicians and Other Health Care Professionals

An Ohio podiatrist was ordered to pay $65,000 in fines and restitution for false statements related to health care matters. Not only did the podiatrist utilize multiple fraudulent billing schemes, but he also forged documents to conceal the fraud. In addition, the podiatrist, who patented a boot-like device, went to several nursing homes to conduct studies on the device and while there, stole Medicare and Medicaid numbers to submit fraudulent billings.

In Virginia, a woman was sentenced on three charges relating to her diverting controlled substances for her own personal use. She was sentenced to 30 days incarceration for each count and ordered to pay a $5,000 fine. The woman was a certified registered nurse anesthetist and was concurrently licensed/certified in at least 14 different states. This enabled the woman to provide temporary anesthesia services throughout the country with the ability to move freely from one job to another. By the time her addiction related behavior was discovered, the nurse was able to gain new temporary anesthesia assignments and carry-on with her addiction. The woman, who had a 20-year history of being addicted to drugs, repeatedly used false statements to cover up her past disciplinary actions and arrests relating to theft of controlled substances.

In New York, a billing clerk was ordered to pay $2,100 in restitution for health care fraud. The billing clerk systematically upcoded claims. These claims had already been upcoded by nurses who routinely treated patients without any physician involvement, but coded the services as though a physician had rendered them.

Prescription Drug Fraud

In Florida, the owner of a pharmacy was sentenced to 60 months in prison and ordered to pay almost $3.3 million in restitution for conspiracy to defraud. The pharmacy owner participated in distributing sub-potent aerosol medication for patients from a clinic. The pharmacist also sold pharmaceutical labels for medication and provided only half portions of medications but billed Medicare for the entire amount. In another aspect of the case, a woman was sentenced to 51 months in prison and ordered to pay $3.5 million in restitution for laundering fraudulent proceeds obtained through various schemes to defraud Medicare.

An Illinois pharmacist was ordered to pay $30,000 in restitution for his role in the theft and distribution of the drug Serostim. The drug was stolen from an AIDS clinic, then sold on the “black market” to bodybuilders. In addition, the pharmacist agreed to give up his license for 4 years.

In Georgia, a woman was sentenced to 10 months in jail and ordered to pay $11,000 in restitution for her involvement in the acquisition and distribution of OxyContin.

Ambulance Companies

In Pennsylvania, a man was sentenced to 32 months incarceration and ordered to pay $111,000 in restitution for embezzlement. As president of a non-profit volunteer ambulance company, the man embezzled funds through a scheme that was discovered during an investigation into allegations of Medicare fraud.

Employee Misconduct

In New Mexico, a woman was ordered to pay over $9,000 in restitution for embezzlement. From January 2001 through July 2001, while serving as a procurement officer for the Indian Health Service, the woman used her government IMPAC credit card to make personal purchases.

Other Cases of Interest

In Oregon, a man was ordered to pay $6,000 in fines and restitution for false statements relating to health care and Social Security fraud.

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July 2003 Criminal Enforcement Report

Child Support Enforcement

In Minnesota, a man was sentenced to 5 years probation and ordered to pay $64,000 in restitution for failure to pay child support. From 1999 through 2001, the man was an executive vice president of a company earning a substantial income. In an effort to conceal his income, he used a slightly different Social Security number.

Durable Medical Equipment

In Washington, a physician was ordered to pay $11,000 in fines and restitution for making false statements. The physician signed prescriptions that were in turn used by various durable medical equipment companies to bill Medicare and Medicaid for custom fitted and custom molded orthotic devices.

Kickbacks

In Pennsylvania, a former chief executive officer and president of a durable medical equipment company was sentenced to 4 months incarceration and ordered to pay a $40,000 fine for conspiracy to pay kickbacks to physicians in return for physicians' referrals.

Physicians and Other Health Care Professionals

In Montana, a registered nurse was sentenced for fraudulently obtaining controlled substances from a hospital where she was employed. From October 2001 through August 2002, the woman stole narcotics and altered narcotic distribution logs in an attempt to conceal the thefts.

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August 2003 Criminal Enforcement Report

Child Support Enforcement

In Ohio, after pleading guilty, a man was sentenced to 5 years probation and ordered to pay $106,000 in restitution for failure to pay child support for his three children. After leaving Ohio in 1995, using an alias name, the man began living as a female. In March 2003, he was arrested in California once OIG agents established his actual identity. In 1999, the man earned approximately $230,000 as a computer programmer.

Durable Medical Equipment

A woman, who was previously convicted by a Florida jury, was sentenced to 21 months confinement for false statements, health care fraud and conspiracy. The woman was also ordered to participate in a drug treatment program as well as an anger management program. In 2000, Medicare assessed the woman's father with an $182,000 overpayment and began withholding money from his durable medical equipment (DME) company. In order to avoid repayment, he created a new DME company in the name of his daughter. According to the Medicare Supplier Number application, the woman asserted that she was the sole owner/manager of the new company, when in fact, her father was the de facto owner/manager and it operated exactly as it did under the previous name. The woman was also sentenced to an additional 12 months confinement to be served concurrently for assaulting an agent during her arrest relating to the health care fraud investigation. The woman's father was previously sentenced in January 2003.

Physicians and Other Health Care Professionals

In New York, a physician and his nurse were sentenced for their involvement in a scheme to defraud the Government. The physician was sentenced to three years and 10 months incarceration and ordered to pay $227,000 in restitution. The physician was previously convicted during a jury trial for health care fraud, conspiracy to distribute and dispense controlled substances, illegal distribution and dispensation of controlled substances, and aiding and abetting. The nurse was sentenced to 6 months home confinement for health care fraud and conspiracy to illegally distribute Schedule II controlled substances. The physician submitted claims to Medicare indicating he had treated the patients and performed the service directly, when actually, a nurse treated the patients. To facilitate this scheme, the physician provided presigned prescription pads for her and other nurses to prescribe narcotic drugs to patients.

A New York psychologist was sentenced to one year and one day in prison and ordered to pay $500,000 in restitution for health care fraud. The psychologist paid a co-conspirator for the use of his provider number. Through this scheme, the psychologist was able to bill and receive payments from Medicare and private insurers for services never provided (nerve block injection treatments), along with physical therapy treatments the psychologist was not allowed to perform or bill. The co-conspirator was previously sentenced for his involvement in the scheme.

Employee Misconduct

In South Dakota, two former Indian Health Service (IHS) employees were each ordered to pay $3,000 in restitution for their submission of fraudulent travel vouchers. The two IHS employees submitted travel vouchers claiming mileage for a personally owned vehicle and for individual lodging expenses, but actually used a Government owned vehicle and shared lodging. The extra compensation they received was then shared.

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September 2003 Criminal Enforcement Report

Child Support Enforcement

In Florida, a man was sentenced to 12 months in prison, 12 months probation, 25-hours community service and ordered to pay full restitution for failure to pay child support. As of August 2003, he owed approximately $56,000 in overdue support. In the early 1990's, the man was ordered to pay $55 a week for his child who suffered from severe autism. Shortly thereafter, the man inherited nearly $750,000 and then virtually disappeared, leaving no trace of employment or even a residence for 10 years. Investigation revealed that while the custodial parent was receiving assistance from Medicaid, the man progressively spent all of the money on suspected drug usage and trips to Norway. In 2002, he was located living in a rural area in Washington State.

Durable Medical Equipment

In Michigan, a man was sentenced to 63 months incarceration and ordered to pay $1 million in restitution for defrauding Medicare, Medicaid and a private insurer. In addition, the man forfeited $1 million in assets obtained through the fraud. As an owner of a durable medical equipment company, the man persuaded elderly patients to purchase motorized wheelchairs they did not need.

Prescription Drug Fraud

In Florida, as a result of a joint investigation with the Food and Drug Administration, three subjects were sentenced for their role in a scheme to defraud Medicare. The three subjects were each sentenced to serve time in jail and were ordered to pay a combined total of $31,000 in restitution. During the investigation, it was revealed that the defendants were engaged in a scheme to traffic in what was purported to be Procrit but was actually water. Procrit is a Medicare covered drug for the treatment of anemia for use by cancer and HIV patients.

Ambulance Companies

In Illinois, a man was sentenced to 2 years probation and ordered to pay a $100 fine for false statements. The man, who worked for an ambulance service, lied to agents about destroying ambulance run sheets and other pertinent evidence at the ambulance service.

Nursing Home

In Illinois, a bookkeeper at a nursing home was sentenced to 12 months incarceration and ordered to pay the nursing home $23,000 in restitution for theft of monies from an entity receiving Federal funds. As the bookkeeper, the woman had complete charge and signature authority on all of the patient trust fund accounts. Over a two-year period, she embezzled over $23,000 from the accounts of the most vulnerable residents with no next of kin and who were wards of the State. The bookkeeper took money from a woman who had no money, died, and subsequently had to be buried in a paupers' field with no headstone. She used the funds for drinking at local bars and gambling at riverboat casinos. As part of her sentence, she must seek mental health assistance, along with alcohol and gambling abuse counseling.

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October 2003 Criminal Enforcement Report

Durable Medical Equipment

In Washington, two former owners of a durable medical equipment (DME) company were sentenced for their role in a scheme to defraud the Government. The man, who was convicted in a jury trial, was sentenced to 46 months in prison and ordered to pay a special court assessment of $4,600; he is subject to deportation to Russia after he serves his sentence for procuring U.S. citizenship contrary to the law. The woman, who pled guilty, was sentenced to 1 year and 1 day in prison. In addition, the two were ordered jointly and severally to pay almost $195,000 in restitution. The defendants fraudulently billed Medicare and Medicaid for expensive orthotics and incontinence supplies. As part of the scheme, the woman, a Russian interpreter, offered gifts to patients who were then transported to doctors' offices to obtain prescriptions for DME.

Physicians and Other Health Care Professionals

A Michigan dentist was sentenced to 1 year and 1 day incarceration and ordered to pay $743,000 in restitution and fines for mail fraud. The man billed insurers for services not performed and for upcoded dental services.

In Massachusetts, a man was ordered to pay a $5,000 fine and pay $40,000 in restitution to a hospital. Although not actually licensed, by providing false information, the man purported to be a licensed pharmacist and worked in a hospital pharmacy department from 1982 through 2001.

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November 2003 Criminal Enforcement Report

Child Support Enforcement

In Nevada, a man pled guilty and was ordered to pay a $5,000 fine for failure to pay child support. At the court hearing, the man paid $63,000 to satisfy his arrearage in full. Since 1990, the man concealed his assets through a business partner and other associates. Over a two-year period, he also wired over $450,000 from business accounts to personal accounts in an effort to avoid paying child support.

Physicians and Other Health Care Professionals

Pursuant to his guilty plea, a California Otolaryngologist was sentenced to 6 months incarceration for mail fraud. The man previously agreed to pay the Government $1 million and agreed to a 15-year exclusion to resolve his civil liability. The man routinely billed for surgical nasal endoscopies that were not performed and billed for unnecessary ancillary tests.

Prescription Drug Fraud

In Maryland, a woman was found guilty on 9 counts of a 41-count indictment relating to her involvement in a drug distribution scheme. On one count alone, the woman was ordered as part of her sentence to be incarcerated for 10 years without the possibility of parole; she was also ordered to pay $100,000 in restitution to the Medicaid program. In a joint investigation with the Medicaid Fraud Control Unit, it was discovered that while employed at a clinic serving the developmentally disabled community, the woman used her position to gain access to prescription pads and a document stamp that was used to authenticate prescriptions for controlled substances.

Psychological and Psychiatric Services

In Georgia, a licensed clinical social worker (LCSW) was sentenced to 12 months and 1 day incarceration and ordered to pay $74,000 in restitution for submitting false claims to Medicare. From 1999 through 2002, the LCSW submitted claims to Medicare for psychotherapy services he did not render. On numerous occasions, he billed for more than 24 hours worth of psychotherapy services in a day and also submitted claims for dates of service when he was actually out of town. The man went door-to-door in senior citizens' facilities to solicit beneficiaries, telling them that he could provide them with free "social services." During the investigation, it was discovered that he provided false information on his application to become a LCSW by failing to disclose past criminal history.

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December 2003 Criminal Enforcement Report

Durable Medical Equipment

In Indiana, a woman was sentenced to 51 months imprisonment and ordered to pay over $1.9 million in restitution for health care fraud, mail fraud and for unlawful kickbacks. In addition, she is currently undergoing criminal forfeiture of her assets, including a $1 million home and assets of two related businesses. The woman was the president/owner of a DME and pharmaceutical supplier that billed Medicare, Medicaid, and Tri-Care for injectible solutions, IV therapies, and other selected services and supplies in highly excessive quantities. She often billed for more supplies in a week than patients could use in a year.

In Florida, two remaining subjects were sentenced related to various charges for their role in a DME fraud scheme. The mastermind of the conspiracy was sentenced to 87 months in prison, and the other defendant was sentenced to 53 months in prison. In addition, they were ordered to pay over $1.7 million in restitution, jointly and severally with other co-defendants. The subjects involved in the scheme defrauded the Medicare program in connection with approximately $5 million worth of fraudulent claims for the cost of power wheelchairs and accessories that were allegedly supplied by two companies.

Physicians and Other Health Care Professionals

In Utah, a nurse practitioner was ordered to pay almost $3,000 in restitution for false claims and aiding and abetting. From 1994 until her clinic closed in April 2001, the woman submitted claims for services she provided using the names and personal identification numbers of physicians not associated with the clinic.

In South Dakota, a woman was ordered to perform 80 hours of community service for false statements relating to health care matters. In addition, she was ordered to write a letter of apology to the members of an Indian reservation. The woman was charged pursuant to an OIG investigation into alleged substandard care provided at a facility resulting in the deaths of seven patients from the Indian reservation during a 6-month period. The woman, who was the facility charge nurse, routinely altered patient records and shredded, or ordered to be shredded, patient care records to conceal life-threatening treatment errors. She also documented patient files for medications not given.

Employee Misconduct

In Maryland, a former NIH scientist was sentenced to 18 months incarceration for knowingly receiving child pornography. In addition, the man must participate in a mental health treatment program, register as a sex offender, and not access a computer or the Internet without prior approval from the Division of Probation.

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