In key enforcement actions announced by the U.S. Department of Justice (DOJ) last week that involved the healthcare industry, three defendants were either convicted or sentenced for their roles in various healthcare fraud schemes and two others were charged in a fraud/kickback scheme. Here’s a quick summary of the four enforcement actions:
April 27: The owner of Portable Radiology Services, a radiology business in North Canton, Ohio, was convicted after a five-day trial in Cleveland for his role in a $2 million health care fraud scheme. According to a statement from the DOJ, the owner billed Medicaid and Medicare for X-ray related services that Portable Radiology Services never provided, made false statements to cover up that fraud, and committed “aggravated identity theft.” The owner is set to be sentenced in August and likely faces jail time with each count of healthcare fraud carrying a maximum of 10 years in prison, the healthcare-related false statements carrying a five-year maximum sentence, and the identity theft counts carrying a mandatory minimum two-year prison sentence, according to the DOJ.1
April 27: A physician operating a clinic in Richland, Washington was sentenced to four years in prison for conspiring to distribute various controlled substances, including opioid pain medications, without a legitimate medical reason and “outside the usual course of professional practice,” the DOJ said in a statement. The physician also faces three years’ federal supervised release once she has completed her sentence. Five other defendants were also involved in the scheme, with two others having also been sentenced to prison time. Two others are to be sentenced this month.2
April 28: A California doctor was sentenced to 93 months in prison for his role in a $12 million Medicare fraud and device adulteration scheme. According to the DOJ, the doctor recruited Medicare beneficiaries to his clinics, falsely diagnosed those patients, and then provided them with medically unnecessary procedures. When billing Medicare, the doctor engaged in upcoding, using a code for more expensive procedures that he didn’t actually perform. In the device adulteration scheme, the doctor re-packaged single-use catheters for re-use on patients. He also submitted false declarations in a bankruptcy proceeding. He billed Medicare $12 million for procedures he performed, of which he received $4.5 million. In addition to the 93-month prison term, he faces three years of supervised release and must pay back more than $4.5 million in restitution to Medicare.3
April 28: A patient recruiter and the owner of Elitte Healthcare and Service Inc., a home health agency in Houston, Texas, were arrested and charged in a $10 million fraud/kickback scheme. According to a DOJ statement, the owner of Elitte allegedly billed Medicare for services that were never actually provided and then made fake medical records. The owner also allegedly paid kickbacks to Elitte’s patient recruiter as well as other marketers employed by the health agency and patients for new patient referrals and billed Medicare for health services provided to marketers while they were transporting patients. Allegedly, Elitte and its owner fraudulently billed Medicare more than $10 million. Both the owner and patient recruiter face a potential $250,000 maximum fine and up to 10 years in prison if they are convicted.4
References:
- https://www.justice.gov/usao-ndoh/pr/north-canton-radiology-business-owner-convicted-trial-2-million-health-care-fraud
- https://www.justice.gov/usao-edwa/pr/richland-physician-sentenced-four-years-prison-conspiring-distribute-medically
- https://www.justice.gov/opa/pr/doctor-sentenced-12-million-medicare-fraud-and-device-adulteration-scheme
- https://www.justice.gov/usao-sdtx/pr/two-charged-10m-medicare-fraudkickback-scheme