North Carolina
News Archive: 2009 Quick Reference: September 13, 2010 - Wake Forest Man Sentenced In Health Care Fraud Scheme Greenville – Read More September 10, 2010 - Linden Woman Sentenced For Health Care Fraud Raleigh – Read More March 23, 2010 - Aulander Woman Sentenced for Charges Related to Health Care Fraud Exceeding More Than $650,000 - Read More March 4, 2010 - Wake Forest Man Pleads Guilty to Health Care Fraud - Read More March 2, 2010 - Raleigh Man Sentenced for Making $12.64 Million in Fraudulent Medicare Claims - Read More |  |
Wake Forest Man Sentenced In Health Care Fraud Scheme Greenville (U.S. Attorney’s Office of the Eastern District of North Carolina)
Greenville, NC. – United States Attorney George E.B. Holding announced September 13th, 2010, that in federal court on September 10, 2010, Chief United States District Judge Louise W. Flanagan sentenced Steven Thompson, 42, to 58 months’ imprisonment followed by three years’ supervised release for fraudulently obtaining Medicare Part D payments for prescription drugs. The Court also imposed restitution in the amount of $17,650. A Federal Grand Jury returned a Criminal Indictment on December 17, 2009. On March 3, 2010, Thompson, pled guilty to health care fraud, in violation of Title 18, United States Code, Section 1347. In January, 2006, Thompson, being disabled, enrolled in the Medicare Part D Plan that paid for his prescription medications. This part of the Medicare program subsidizes the costs of prescription drugs for Medicare beneficiaries. During the course of the investigation, a review of 310 prescription records, from January, 2006, to June, 2008, revealed that Thompson utilized the services of over 104 physicians and had 282 prescribed analgesics/narcotics which had been filled at over 20 different pharmacies. As of November, 2009, the cost of Thompson’s fraudulently obtained prescription medications paid by Medicare totals $45,195.
Mr. Holding commented, “A growing concern for our nation is the abuse of prescription medications. This defendant went to great lengths to hide his abuse through the use of many physicians and pharmacies and the investigators of this case must be commended for their hard work. This type of drug abuse and the fraudulent methods used to obtain the drugs places an even further burden on our already taxed government health care system and we must remain vigilant to stop the abuse.”
Investigation of this case was conducted by the Department of Health and Human Services, office of Inspector General; the Drug Enforcement Administration and the North Carolina State Bureau of Investigation. Assistant United States Attorney Ethan Ontjes is prosecuting the case for the United States.
Linden Woman Sentenced For Health Care Fraud Raleigh (U.S. Attorney’s Office of the Eastern District of North Carolina)
United States Attorney George E.B. Holding announced that in federal court on September 10th, 2010, United States District Judge Terrence W. Boyle sentenced Sandra Elliott, 47, of Linden, North Carolina, to 120 months’ imprisonment followed by three years’ supervised release. The Court also ordered restitution of $1,885,196.40. A Criminal Information was filed on December 30, 2009. On January 15, 2010, Elliott pled guilty to aiding and abetting health care fraud.
In 2006, Elliott opened Learning Links Educational Network Services Center, Inc. (“Learning Links”) in Fayetteville, North Carolina. Learning Links purported to provide early intervention treatment for children with developmental delays, anger management problems, or other special needs. When a physician ordered that a child receive mental health services or early intervention treatment, Learning Links purported to provide the services through its employees or contractors. Learning Links also purported to provide tutoring. Learning Links primarily billed and received payments from Medicaid and Tricare, both of which are health care benefit programs. Tricare is a benefit program for military members and their dependents. Medicaid is a federally subsidized program administered by North Carolina for economically disadvantaged or disabled individuals. Through its routine billing to these programs, Elliott expanded the Learning Links operation to four locations in Fayetteville and Dunn, and was planning to open other facilities.
In 2009, law enforcement executed search warrants at all four Learning Links locations and seized all medical records and email correspondence. Through seized documents and interviews, law enforcement confirmed that Learning Links was billing for services that were not rendered and employing unlicensed personnel to provide various billed services to children, including psychotherapy. Investigators learned that the Medicaid and TRICARE identification numbers associated with some 623 special needs children were abused as part of the scheme. Investigators also learned that in some instances, the children who allegedly received services at Learning Links were not even in the state on the billed date of service. In other instances, Learning Links billed for services to children several months after they had stopped treatment at Learning Links. It was also discovered that practitioners who were no longer working for Learning Links were still being listed on Learning Links’ billing submissions as the provider of services. Moreover, some of the individuals providing services to children at Learning Links did not possess the requisite licenses for the billed services. Unlicensed services included speech and language therapy, and psychological services.
The total loss to the government arising from the health care fraud was calculated to be $1,885,196.40, with $1,172,647.62 attributed to the TRICARE program and $712,548.78 attributed to Medicaid. Law enforcement seized in excess of $345,000 in assets which have now been forfeited to the United States, including a 2008 Fleetwood Terra RV, a 2009 Lexus GX470, a 2008 Chrysler 300, and cash from various bank accounts.
Investigation of this case was conducted by the Defense Criminal Investigative Service, the North Carolina Department of Justice Medicaid Fraud Investigations Unit, the TRICARE Program Integrity Office, and the Health Net Federal Services Office of Program Integrity. This case is being handled by the Office’s Economic Crimes Section, with Assistant United States Attorney William M. Gilmore assigned as prosecutor.
Aulander Woman Sentenced for Charges Related to Health Care Fraud Exceeding More Than $650,000 (U.S. Attorney for Eastern District of North Carolina)
Raleigh, North Carolina - United States Attorney George E.B. Holding announced that in federal court, on March 23, 2010, United States District Judge James C. Dever, III, sentenced Faith Elaine Sumner, 43, of Aulander, North Carolina, to 46 months’ imprisonment followed by three years’ supervised release. In accordance with the plea agreement, the Court imposed restitution of $677,272.
A Criminal Information was filed on November 13, 2009, charging aiding and abetting health care fraud, in violation of Title 18, United States Code, Sections 1347 and 2. On December 7, 2009, Sumner pled guilty to the charge.
From 2006 to 2008, Sumner, who worked as an office manager for Preferred Medical Transport (PMT), unlawfully billed the government for over $650,000. PMT is a medical transport company for Medicare and Medicaid recipients. While working as office manager, Sumner submitted false claims for reimbursement for ambulance transports of clients going to and from dialysis treatments. Dialysis treatment transports are usually routine and of a non-emergency nature and performed via wheelchair van. However, during the investigation it was determined that Sumner routinely falsified trip records and related documents indicating the patient was transported by ambulance for “medical necessity.” Mr. Holding commented, “Health care fraud is a serious offense. Those who believe that they can defraud the government and easily get away with it will find that they will be caught and prosecuted. The government, both at the state and federal levels, have investigators to seek out fraud, when it occurs, and my office stands ready to prosecute those who try to take advantage of the system.”
Investigation of this case was conducted by the United States Department of Health and Human Services and the North Carolina Department of Health and Human Services. Attorney Ethan Ontjes represented the government.
Wake Forest Man Pleads Guilty to Health Care Fraud (U.S. Attorney for the Eastern District of North Carolina)
GREENVILLE - United States Attorney George E.B. Holding announced on March 4, 2010, that in federal court yesterday a Wake Forest man pled guilty to fraudulently obtaining Medicare Part D payments for prescription drugs. Steven Thompson, 42, pled guilty before United States Magistrate Judge David W. Daniel to health care fraud, in violation of Title 18, United States Code, Section 1347.
A Federal Grand Jury returned a Criminal Indictment on December 17, 2009.
In January, 2006, Thompson, being disabled, enrolled in the Medicare Part D Plan that paid for his prescription medications. This part of the Medicare program subsidizes the costs of prescription drugs for Medicare beneficiaries. During the course of the investigation, a review of 310 prescription records, from January, 2006, to June, 2008, revealed that Thompson utilized the services of over 104 physicians and had 282 prescribed analgesics/narcotics which had been filled at over 20 different pharmacies. As of November, 2009, the cost of Thompson’s fraudulently obtained prescription medications paid by Medicare totals $45,195.
Mr. Holding commented, “Drug abuse through prescribed medications is a growing concern for our nation. The investigators of this case must be commended for their hard work in piecing together the many physicians and pharmacies the defendant used to try to hide his illegal activities. We must remain vigilant in order to stop this growing form of drug abuse and the fraudulent methods used to further burden our already taxed government health care system.”
At sentencing, scheduled for June 1, 2010, Thompson faces up to 10 years imprisonment followed by up to three years supervised release and a fine of up to $250,000.
Investigation of this case was conducted by the Department of Health and Human Services, office of Inspector General; the Drug Enforcement Administration and the North Carolina State Bureau of Investigation. Assistant United States Attorney Ethan Ontjes is prosecuting the case for the United States.
Raleigh Man Sentenced for Making $12.64 Million in Fraudulent Medicare Claims (U.S. Attorney for the Eastern District of North Carolina)
RALEIGH - United States Attorney George E.B. Holding announced that in federal court yesterday United States District Judge James C. Dever, III, sentenced Kalu Kalu, 46, of Raleigh, North Carolina, to 90 months’ imprisonment followed by three years supervised release. Restitution in the amount of $4,611,988 was also imposed.
A Federal Grand Jury returned a Criminal Indictment on February 19, 2009. On September 8, 2009, Kalu pled guilty to conspiring to commit health care fraud and aiding and abetting health care fraud.
According to the investigation, from approximately December, 2004, through July, 2008, Kalu, d/b/a Enuda Healthsource, Universal Medical Supply, and States Medical Supply, along with a second codefendant, Martin Ifeani Iroegbu, d/b/a Divine Medical Equipment, engaged in a scheme to bilk Medicare out of over $12.64 million by causing fraudulent payments to be made by Medicare for durable medical equipment (DME) that was either not necessary, not needed, or not delivered.
The investigation revealed that employees of the companies would give presentations at patient's homes or churches giving the impression that Medicare was giving DME to those patients that asked for it at no cost to the patient. The Medicare beneficiaries would then be asked about their medical conditions and the names of their physicians and their Medicare numbers would be obtained. A physician order/prescription form (“prescription”), would then be completed with the original being sent to the primary physician for the physician's signature and then returned. Often times the “prescriptions” were denied, or sometimes the physicians would mark through the items not needed and sign for other items that they felt were needed.
The defendants would still bill Medicare for DME that was denied by the physicians, that was not medically necessary, that was not requested by the patient’s physician, or, in some cases, that was not the correct item or that was never delivered to the patient. Often times, the defendants would bill Medicare for more expensive equipment than was delivered to the Medicare beneficiaries.
Mr. Holding commented, “The Medicare system was enacted to assist retired and elderly citizens in obtaining needed health care. Unfortunately, this defendant targeted this system as an easy mark, bilking the American taxpayer out of millions of dollars. We stand committed to assist our federal investigative agencies in bringing to justice those who illegally benefit from a system in which hardworking, honest taxpayers have invested.”
Investigation of this case was conducted by the Office of Health and Human Services, Office of Investigations and the Federal Bureau of Investigations. This case is being handled by the Office’s Economic Crimes Section, with Assistant United States Attorney Felice McConnell Corpening assigned as prosecutor.
