Health Care Fraud and Abuse Control Program – Annual Report for Fiscal Year 2009

The Department of Health and Human Services and the Department of Justice have issued a report: “Health Care Fraud and Abuse Control Program – Annual Report for Fiscal Year 2009.” The report includes a few cases where the defendants were charged with identity theft among other charges:

In Florida, the owner and operator of a DME company was sentenced to 54 months’ incarceration and ordered to pay $807,000 in restitution pursuant to his guilty plea to health care fraud and aggravated identity theft. The owner admitted that beginning in January 2004, he fraudulently billed Medicare for DME which were not delivered, were not prescribed by the physicians listed on the claims, or were not medically necessary. In addition, the owner acknowledged that he knowingly and willfully stole the identity of a Medicare beneficiary for the purpose of submitting false claims.

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In California, an owner and operator of a Los Angeles-area durable medical equipment company pleaded guilty to charges of aggravated identity theft and health care fraud and was sentenced to 54 months in prison and ordered to pay $807,000 in restitution. He admitted submitting false claims for orthotic braces, power wheelchairs, and other DME that were not delivered to Medicare beneficiaries, were not prescribed by the physicians listed on the claims that he made or were not medically necessary. He also acknowledged stealing the identity of a Medicare beneficiary and billed Medicare for a back brace and two knee braces that the beneficiary did not need or receive, and of which the patient had no knowledge.

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In Florida, the two owners of a medical billing company were each sentenced to 168 months in prison for health care fraud and conspiracy to commit health care fraud. In addition, an employee was sentenced to 132 months in prison for aggravated identity theft and conspiracy to commit health care fraud. The owners were ordered to pay $125.7 million in restitution and forfeit various pieces of real estate. The medical billing company submitted claims to Medicare on behalf of suppliers who purportedly provided DME to Medicare beneficiaries. These claims were for equipment that had not been ordered by physicians or delivered to the beneficiaries as claimed.

The entire report is available on the DOJ’s web site.

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