The U.S. Department of Justice has announced that two Texas men have been sentenced to lengthy prison terms for their alleged participation in a Medicare fraud scheme involving durable medical equipment (“DME”). The manager and driver for a Houston, Texas DME company received prison sentences of 120 months and 41 months, respectively, for their alleged participation in the Medicare fraud scheme, with both to serve three years of supervised release following their incarceration.
The manager was also ordered to pay $453,112 in restitution and the driver was ordered to pay $80,000 in restitution. The manager was convicted of three counts of health care fraud and one count of conspiracy to commit health care fraud after a one week trial during July, 2010 (he reportedly had a prior fraud conviction that he never reported to Medicare). The driver reportedly knew that durable medical equipment that he delivered was medically unnecessary and, in some cases, unwanted by the Medicare beneficiaries.
The Medicare DME fraud scheme started in 2007 when the DME company began submitting bills to Medicare for medically unnecessary medical equipment that included power wheelchairs that were billed as being related to Hurricanes Katrina, Rita, Ike, and Gustav. The bills submitted to Medicare were in excess of $1.1 million. Many of the Medicare beneficiaries for whom bills were submitted to Medicare for payment related to powered wheelchairs that were either never owned by the Medicare beneficiaries during the catastrophe-related periods or the Medicare beneficiaries owned power wheelchairs but their power wheelchairs were not damaged during the natural catastrophe periods.
While the federal sentencing of the convicted manager and driver for the Texas DME company occurred in November, 2010, the issue of Medicare fraud is ongoing and rampant.
The Texas case was brought by the Health Care Fraud Prevention and Enforcement Action Team (“HEAT”), which is a joint effort between the Department of Health and Human Services (“HHS”) and the Department of Justice (“DOJ”) to fight health care fraud. A key component of HEAT is the “Medicare Strike Force,” which consists of “interagency teams of analysts, investigators, and prosecutors who can target emerging or migrating fraud schemes, including fraud by criminals masquerading as healthcare providers or suppliers.”
As reported by the U.S. government:
In 2011, HEAT coordinated the largest-ever federal health care fraud takedown involving $530 million in fraudulent billing. In one action, Strike Force teams charged 115 defendants in nine cities, including doctors, nurses, health care company owners and executives, for their alleged participation in Medicare fraud schemes involving more than $240 million in false billing. In another coordinated takedown, Strike Force prosecution teams charged 91 defendants in eight cities for their alleged participation in a Medicare fraud scheme involving more than $290 million in false billings…
In October 2012, Medicare Fraud Strike Force operations in seven cities led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $432 million in false billing. That total includes more than $230 million in home health care fraud; more than $100 million in community mental health care fraud and more than $49 million in ambulance transportation fraud. In coordination with the criminal charges, HHS also suspended or took other administrative action against 30 health care providers following a data-driven analysis and credible allegations of fraud. Under the Affordable Care Act, HHS is able to suspend payments until an investigation is complete. In May 2012, Medicare Strike Force teams charged 107 individuals, including doctors, nurses and other licensed medical professionals, in seven cities for their alleged participation in Medicare fraud schemes involving more than $452 million in false billing.
If you believe that you may be the victim of Medicare fraud by a health care provider or a durable medical equipment provider, you should promptly report your suspicions to Medicare. Click here to be forwarded to an official U.S. government website to learn how to report suspected Medicare fraud.
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