Recent OIG Enforcement Actions

April 4, 2008

In California, a physician was sentenced to 30 months in prison and ordered to pay $558,000 in restitution for his involvement in a conspiracy to defraud the Medicare program. The physician wrote prescriptions and signed certificates of medical necessity for enteral nutrition products, motorized wheelchairs, and hospital beds that were not necessary and, in most cases, were not provided to beneficiaries. The physician received kickbacks from a DME company for each fraudulent prescription. In addition, the physician billed Medicare for treating patients who were recruited to come to his clinic with the promise of receiving free ensure products. Patients were then referred for ancillary services for which the physician received kickbacks from companies he referred patients to.

In Illinois, a psychologist was sentenced to 22 months in prison and ordered to pay $170,000 in restitution for health care fraud. The psychologist billed Medicare for group and individual psychotherapy services that he did not provide. An investigation revealed that the psychologist, who visited facilities once or twice a week to conduct assessments, billed Medicare for psychotherapy services provided to patients 4 to 5 days a week that were either not performed as billed or were for dates of service when he was not actually present at the facilities. In 2005, the psychologist fled the U.S. to Israel. In April 2007, he was arrested by Israeli National Police and in September he was extradited back to the U.S. where he pled guilty.

In New Jersey, a podiatrist was sentenced to 24 months in prison and ordered to pay $350,000 in restitution for his guilty plea to health care fraud. An investigation revealed that the podiatrist performed routine foot care on residents in community rooms of low-income buildings then billed the Medicare program as if he performed more complex procedures. In fact, residents were only getting their nails clipped. In August 2007, the podiatrist agreed to pay $868,000 to resolve his false claims act liability for the same conduct.

In Georgia, a respiratory therapist was sentenced to 5 years in prison and ordered to pay $2.7 million in restitution for conspiracy to commit health care fraud. The respiratory therapist, who worked in a hospital, provided false blood test results for patients so a DME provider could in turn bill Medicare and Medicaid for unnecessary oxygen treatments.

In Colorado, a licensed clinical social worker (LCSW) was sentenced to 6 months of home detention and ordered to pay $63,000 in restitution for mail fraud. The LCSW billed Medicare for counseling services never rendered. Investigation revealed that the LCSW billed for more than 150 dates of services for a beneficiary that she actually only saw once. Medicare also denied claims billed for dates of services for 2 of her patients that occurred after their dates of death.

In Pennsylvania, an owner/operator of a mental health facility was sentenced to 5 years in prison and ordered to pay over $280,000 in restitution and fines after being found guilty on all charges contained in a 49-count indictment. The woman and her company fraudulently obtained individual and group provider identification numbers from Medicare and then used those numbers to submit false and fraudulent claims for psychiatric and psychotherapy services. An investigation revealed that services were not rendered as billed or provided by licensed professionals.

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