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Criminal and Civil Enforcement

January 2005 Criminal Enforcement Report

Hospitals, Laboratories, and Clinics

In Texas, a woman was ordered to pay $964,000 in restitution for her involvement in a scheme to defraud. During a 6-month period, the woman and her co-defendant, who owned and operated two physical therapy clinics, billed Medicare for evaluations and services that were not performed, billed for services provided by unlicensed technicians without necessary supervision, and paid kickbacks to individuals that referred patients to the clinics. When the two clinics closed, the woman operated another clinic and continued her fraud scheme. In November 2004, the co-defendant was sentenced and held jointly responsible for $894,000 of the restitution amount.

In California, the owner of a laboratory company was sentenced to 10 months incarceration and ordered to pay $180,000 in restitution for health care fraud. The man billed Medicare for diagnostic tests, including echocardiograms and ultrasounds, which were not ordered by a physician and were never interpreted by a physician.

Physicians and Other Health Care Professionals

In Washington, a doctor was sentenced to 12 months and 1 day in prison and ordered to pay $46,000 in restitution and a $100,000 fine for health care fraud. The doctor billed for services not rendered or for services that were upcoded.

Durable Medical Equipment

In Florida, a man was sentenced to 18 months in prison for his involvement in a money laundering scheme. In addition, the man will be deported to Peru after his sentence. The man's advertising company served as a vehicle to launder over $2.5 million in Medicare funds for eight Miami-based medical organizations. The investigation revealed that the DME companies and pharmacies involved in the scheme billed for equipment or services for beneficiaries who either had no need for, or did not receive, the equipment or services.

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February 2005 Criminal Enforcement Report

Physicians and Other Health Care Professionals

In Florida, two chiropractors were each sentenced to six months home detention, ordered to pay a $10,000 fine and pay $400,000 in joint and several restitution for their involvement in a variety of fraud schemes. Among other things, the chiropractors were involved in an illegal kickback arrangement with a diagnostic company, billed Medicare using a physicians' Medicare number without his knowledge or consent, utilized unlicensed and unsupervised personnel to perform procedures, billed chiropractic services as physical therapy, and routinely upcoded services.

Employee Misconduct

In South Dakota, a former Indian Health Service (IHS) employee was sentenced to 200 hours of community service and ordered to pay a $6,000 fine for false statements involving Federal health care programs. The woman was a medical records technician at an IHS hospital. Investigation revealed that during a two-year period, in order to save time and avoid workload backlogs, the woman entered the same diagnosis code for patients seen in the emergency room regardless of their medical condition.

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March 2005 Criminal Enforcement Report

Transportation Fraud

In Delaware, the co-owner of a non-emergency transportation company was ordered to pay $88,000 in restitution for health care fraud. Investigation revealed that Medicaid was billed for trips to non-medical destinations, trips that never occurred, and for escorts that were not present.

Physicians and Other Health Care Professionals

In California, a doctor was fined $5,000 pursuant to his guilty plea for importing an unapproved drug from the United Kingdom. In addition to the sentencing, a $150,000 civil settlement was reached. The settlement resolved the doctor's liability for billing vein procedures performed on patients using the unapproved drug.

Child Support Enforcement

In Ohio, a man was sentenced to 5 years probation and ordered to pay $52,000 in restitution for failure to pay child support. In 1988, the man was ordered to pay support for his three children. He made sporadic payments until May 1997 at which time he stopped paying completely. As part of his probation, the man was ordered to participate in a drug treatment program.

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April 2005 Criminal Enforcement Report

Durable Medical Equipment

In Texas, a durable medical equipment (DME) company owner was sentenced to 24 months in prison and ordered to pay $265,000 in restitution for health care fraud. The woman allowed a DME company owner, whose provider number was revoked, to use her provider number to bill Medicare for power wheelchairs that were either not provided or not medically necessary. The two split the Medicare proceeds.

In Illinois, a man was ordered to pay a $10,000 fine for violating the anti-kickback statute. As a sales manager for a large medical equipment distributor, the man provided enteral pumps at no charge in order to induce the purchase of related enteral products and advised nursing homes on how to submit charges to Medicare for the enteral pumps.

Prescription Drug Fraud

In Massachusetts, a former pharmacist for a hospital was sentenced to 42 months in prison and ordered to pay $507,000 in restitution for charges related to diverting pharmaceuticals to a New Jersey pharmacist. As a buyer for the hospital, the pharmacist ordered and authorized the hospital to pay for prescription drugs and other pharmaceuticals, which he diverted on numerous occasions.

Child Support Enforcement

In North Carolina, a man was sentenced to 8 months imprisonment, 1 year supervised release and ordered to pay $77,000 in restitution for failure to pay child support. The man, who resides in Oklahoma, failed to pay any support for his daughter who suffers from cerebral palsy.

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May 2005 Criminal Enforcement Report

Kickbacks

In California, a physician was sentenced to 5 months in prison, 150 days home confinement and ordered to pay $120,000 in restitution for illegal remuneration. The physician accepted kickbacks in exchange for the use of his provider number, which was used to fraudulently bill Medicare, Medi-Cal and private insurers for services provided by unqualified individuals.

Child Support Enforcement

In Vermont, a man was sentenced to 5 years probation and ordered to pay approximately $58,000 in restitution for failure to pay child support for his three children. He was arrested in September 2003 during “Operation Lost and Found”, a national round-up of child support defaulters. In 1999, the man was ordered to pay over $1,000 per month. In 2001, the court reduced his monthly obligation amount to $600 per month. The investigation revealed that the man worked as a mechanic and a truck driver.

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June 2005 Criminal Enforcement Report

Practitioners

In Utah, pursuant to his guilty plea, a doctor was sentenced to time served and ordered to pay $146,000 in restitution. The doctor billed Medicare, Medicaid and private insurers for IV therapy but actually treated patients with chelation therapy, a non-covered service. In Wisconsin, a cardiologist was ordered to pay a $5,000 fine for transporting an unapproved medical device which he used in a medical procedure. In March 2005, the cardiologist entered into a $1 million settlement with the Government to resolve his liability under the False Claims Act for allegedly submitting claims to Medicare for medical procedures using the unapproved medical device.

Kickbacks

In Louisiana, the former owner/administrator of a geriatric psychiatric facility was sentenced to 15 months in prison and ordered to pay $313,000 in restitution for health care fraud and for illegal payment of kickbacks. The man failed to disclose a related party on the facility's 1999 cost report and paid marketers for Medicare referrals. In addition, for receiving illegal kickback payments, a marketer was ordered to pay $67,000 in restitution.

Child Support Enforcement

In Illinois, pursuant to his guilty plea, a man was sentenced to 5 years probation and ordered to pay $48,000 in restitution for failure to pay child support. A former law enforcement officer, the man never made a voluntary payment since ordered in 1992.

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July 2005 Criminal Enforcement Report

Practitioners

In South Carolina, a licensed physical therapist was sentenced to 18 months in prison and ordered to pay $400,000 in restitution for health care fraud. The therapist billed Medicare and a private insurer for three to five hours of therapy when only a one-hour treatment was rendered.

Kickbacks

In Florida, a durable medical equipment (DME) company owner was sentenced to 5 months in prison, 5 months home detention and ordered to pay a $15,000 fine for conspiracy to violate the anti-kickback statute. Investigation revealed that the DME company owner received kickbacks from the owner of a pharmacy in return for referring patients in need of aerosol medications.

Employee Misconduct

In Maryland, a former NIH purchasing agent was ordered to pay $2,400 in restitution for theft of government property. The woman, who pled guilty, used her government-issued credit card to secure rental cars for her own personal use.

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August 2005 Criminal Enforcement Report

Practitioners

An Indiana neuropsychologist was sentenced to 36 months in prison and ordered to pay $291,000 in restitution; he was found guilty of health care fraud following a jury trial in May 2005. Through his two clinics, the neuropsychologist used unlicensed undergraduate students from a State university to perform testing for Medicaid and Medicare patients. In addition, he inflated the number of hours of actual services performed by the unlicensed students.

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September 2005 Criminal Enforcement Report

Prescription Drug Fraud

In Ohio, a woman was sentenced to 22 months in jail, suspended, for her scheme to obtain prescription drugs. While working at a dental office, the woman accessed protected patient information and subsequently used the information to phone in prescriptions to area pharmacies. She called in prescriptions in her name as well as the names of Medicaid recipients.

Durable Medical Equipment

In Texas, the owner of a durable medical equipment company was ordered to pay $546,000 in restitution for billing Medicare for power wheelchairs that were either not provided or were not medically necessary.

Practitioners

In Virginia, a psychologist was ordered to pay $11,000 in fines and restitution for health care fraud. The psychologist submitted fraudulent claims to Medicare for neuropsychological evaluations and testing on nursing home patients. Many of the claims submitted were for dates of service when the psychologist was out of town.

Child Support Enforcement

In South Dakota, a man was sentenced to 21 months in prison, 1 year supervised release and ordered to pay $33,600 in restitution for failure to pay child support. In 1995, the man was ordered to pay $300 a month; he failed to pay any support since 2002.

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October 2005 Criminal Enforcement Report

Medicaid Fraud

In Delaware, the owner/operator of a non-emergency medical transportation company was ordered to pay $30,000 in restitution for health care fraud. Investigation revealed that the Medicaid program was billed for transportation to a drug treatment facility that never occurred.

Other Health Care Professionals

In Pennsylvania, a licensed nurse was sentenced to four months imprisonment and ordered to pay $1,000 in fines and assessments for her guilty plea to health care fraud. A convicted felon, the woman concealed her criminal past from various employers. The woman then utilized her position as a nurse to steal from and defraud patients placed in her care.

Child Support Enforcement

In Oregon, a man was sentenced to 30 days home detention, three years probation and ordered to pay $69,000 in restitution for failure to pay child support for his three children currently in foster care. In a joint Social Security Administration investigation, it was revealed that the man used his son's identity to commit fraud and hide assets.

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November 2005 Criminal Enforcement Report

Durable Medical Equipment

In California, a durable medical equipment (DME) company owner was sentenced to 33 months imprisonment and ordered to pay $170,000 in restitution for health care fraud. Through a highly complicated double-billing scheme, the man received reimbursements totaling 200 percent for power wheelchairs. The DME company owner submitted claims to Medicaid that were previously denied by Medicare. After receiving payment from Medicaid, the man resubmitted claims to Medicare or appealed the original denial, which resulted in the double payment.

Physicians

In Michigan, a doctor was sentenced to 5 months incarceration, 5 months home detention and ordered to pay $120,000 in restitution for health care fraud. The doctor, who was the owner/operator of a neurology center, routinely billed Medicare, Medicaid and a private insurer for two sleep studies when only one was performed.

Employee Misconduct

In Maryland, a former NIH purchasing agent was ordered to pay $12,000 in restitution for theft of Government property. The 20-year employee used her Government issued credit card to pay for her apartment rent, college tuition for her daughter, and kennel services for her dog. The woman resigned from her position.

Medicaid Fraud

In Illinois, a dentist was sentenced to 63 months in prison and ordered to pay $827,000 in restitution and a $20,000 fine; he was found guilty in a jury trial on charges of mail fraud and health care fraud. The dentist performed unnecessary dental procedures on patients and billed for services not performed or not performed as indicated.

Physicians

In Washington D.C., a podiatrist was sentenced to 6 months home detention and ordered to pay $30,000 in restitution for submitting false claims to Medicare. Investigation revealed that the podiatrist billed Medicare for services such as surgery when he actually only provided routine foot care. The podiatrist also submitted claims to Medicare for patients that he did not treat at all.

Child Support Enforcement

In Illinois, a man was sentenced to 22 months in prison, 1 year supervised release and ordered to pay $59,000 in restitution for failure to pay child support. In addition, after his release from prison, the man must obtain full-time employment or work 20 hours per week of community service until he secures a full-time job.

Child Support Enforcement

In Washington, a man pled guilty and was sentenced to 5 years probation and ordered to pay $135,000 in restitution for failure to pay child support. Since their 1991 divorce, the custodial parent has raised their five children on her own. The man worked in Texas and Colorado using an alias.

Durable Medical Equipment

An owner of a DME supply company was sentenced to 2 years imprisonment and ordered to pay $273,000 in restitution and pay a $2,500 fine for mail fraud in connection with a Medicaid fraud scheme. The man submitted claims to Wisconsin's medical assistance program for DME that was never provided.

In Tennessee, the sales manager for a DME supplier was ordered to pay $24,000 in restitution for his role in a scheme to defraud Medicare. A joint investigation with the Federal Bureau of Investigation and the Medicaid Fraud Control Unit revealed that the manager routinely completed the clinical sections of certificates of medical necessity, falsely stating patients had qualifying conditions for alternating pressure mattresses.

Home Health Agency

In Minnesota, the last subject in a complex home health care investigation was sentenced. The woman, a director of nursing, pled guilty and was ordered to pay $53,000 in restitution for health care fraud. Through the woman's involvement in the scheme, home health services were billed that were provided to beneficiaries who were not homebound and/or that were not medically necessary.

Medicaid Fraud

In Washington, a man was sentenced to 30 days in jail and ordered to pay $4,000 in restitution for defrauding the Medicaid program. As the State appointed guardian for his father, he continued to submit claims to Medicaid after his death.

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