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OIG cracks down on fraud in new criminal enforcement actions

Healthcare Auditing Weekly, June 19, 2007

The OIG handed out years in jail time and thousands of dollars in fines as punishments for several instances of healthcare fraud during the month of May. The following are the latest criminal enforcement actions released by the OIG:

In Tennessee, the owner of a physical therapy company pled guilty to violating the anti-kickback statute and was sentenced to four months in prison and ordered to pay $173,000 in restitution. The woman paid kickbacks to doctors based on the percentage of her profits for the patients referred to her company for physical therapy services. During the investigation, it was also revealed that the woman employed unlicensed physical therapists, billed for more therapy than was provided, and prepared fraudulent medical records for a Medicare audit.

In Oklahoma, a physician was sentenced to 33 months in prison and ordered to pay $544,000 in restitution for healthcare fraud. From January 2000 to May 2005, the physician billed for dosages of Remicade and Procrit which far exceeded the amount of those drugs in his inventory.

In Tennessee, a psychologist was sentenced to five months in prison, five months home detention, and ordered to pay $63,000 in restitution for his scheme to defraud Medicare and Medicaid. The psychologist billed Medicare and Medicaid for services provided to beneficiaries at nursing homes that were not rendered. Some of the services billed were for dates of service that occurred after the beneficiaries' date of death, or were for dates of service when the psychologist was not at the nursing home.

In California, a man was sentenced to 18 months imprisonment and ordered to pay $140,000 in restitution for mail fraud. The investigation revealed that the man submitted false information to obtain benefits for which he was not entitled including In-Home Support Services, an HHS-funded program.

Source: OIG

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