North Carolina
Quick Reference: 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 December 11, 2009 - Aulander Woman Pleads Guilty to $650,000 Health Care Fraud - Read More September 9, 2009 - Raleigh Man Pleads Guilty To $12.64 Million In Fraudulent Medicare Claims - Read More | Search for News in Your Area
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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.
Aulander Woman Pleads Guilty to $650,000 Health Care Fraud (U.S. Attorney for the Eastern District of North Carolina)
United States Attorney George E.B. Holding announced that in federal court on Dec. 7, 2009, before United States District Judge James C. Dever, III, FAITH ELAINE SUMNER, of Aulander, North Carolina, pled guilty to health care fraud.
A Criminal Indictment was filed on November 13, 2009, charging aiding and abetting health care fraud, in violation of Title 18, United States Code, Section 1347. 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 ambulatory 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, “Heath care fraud is an increasing concern as individuals believe it is easy to defraud the government and they will not be caught. This is not true. 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.”
The maximum penalty for the charge is up to 10 years imprisonment followed by up to three years of supervised release and a fine of up to $250,000.
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. Assistant United States Attorney Ethan Ontjes represented the government.
More information on the U.S. Attorney for the Eastern District of North Carolina: http://www.usdoj.gov/usao/nce/index.html
Raleigh Man Pleads Guilty To $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 on Sept. 9, that in federal court yesterday KALU KALU, 46, of Raleigh, N.C., pled guilty before United States District Judge James C. Dever, III, to conspiring to commit health care fraud, in violation of Title 18, United States Code, Section 371 and aiding and abetting health care fraud, in violation of Title 18, United States Code, Section 1347.
A Federal Grand Jury returned a Criminal Indictment on February 19, 2009. According to the investigation, from approximately December, 2004, through July, 2008, KALU, d/b/a Enuda Healthsource; co-defendant Kecia Kalu and KALU, d/b/a Universal Medical Supplies, and KALU with a second co-defendant, 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 assisted retired and elderly citizens in obtaining needed health care. Unfortunately, some individuals target this system as an easy mark, bilking millions of taxpayer dollars for themselves. My office is committed to assisting our federal investigative agencies in bringing to justice those who illegally benefit from a system in which hardworking, honest taxpayers have invested.”
The maximum penalties for health care fraud are up to 10 years imprisonment, a fine of up 250,000, and up to three years supervised release. For conspiring to commit health care fraud, the maximum penalties are up to five years imprisonment, a fine of up to $250,000, and up to three years supervised release. Sentencing is set for December 14, 2009.
Investigation of this case was conducted by the Office of Health and Human Services, Office of Investigations and the Federal Bureau of Investigations. Assistant United States Attorney Felice McConnell Corpening represented the government.
