On September 4, 2015, a federal jury in Maryland convicted two Maryland physicians, who are husband and wife, of health care fraud arising out of their ownership and operation of a pain management clinic, after an eight-day trial. The alleged health care fraud involving federal health benefit programs occurred from at least January 2011 through May 2014.
The 60-year-old husband was convicted of one count of health care fraud, two counts of making a false statement related to a health care program, one count of obstruction of justice, four counts of wire fraud, and one count of aggravated identity theft. The 57-year-old wife was convicted of one count of health care fraud, four counts of making a false statement related to a health care program, one count of obstruction of justice, four counts of obstructing an audit, four counts of wire fraud, and two counts of aggravated identity theft. The federal government is seeking forfeiture of at least $2.5 million, which it claims were the proceeds of the fraudulent health care scheme.
The husband specialized in interventional pain management and the wife was a licensed psychiatrist. Together, they owned and operated Washington Pain Management Center (WPMC) located in Greenbelt, Maryland. The federal government alleged that the Maryland physicians defrauded Medicare, Medicaid, TRICARE, Federal Employees Health Benefits Program and the Office of Workers’ Compensation Programs. The federal prosecutors claimed that the defendants filed claims for procedures that were not performed, and they performed less expensive procedures but falsely billed for procedures that provided higher reimbursement amounts. The defendants were alleged to have submitted claims indicating that they had met the requirements for reimbursement, when in fact, they had not met those requirements.
One of the examples of health care fraud the U.S. Attorney’s Office for the District of Maryland cited in its press release issued on September 4, 2015 involved the defendants submitting claims that the husband had performed nerve block injections with the use of an imaging guidance machine, when in fact he neither owned nor used such a machine. The defendants allegedly falsely documented patient files to indicate that an imaging guidance machine had been used to verify needle placement and caused the alteration or destruction of patient files to conceal the scheme from auditors and law enforcement.
As a result of their convictions, the defendants face a maximum sentence of 10 years in prison for each count of health care fraud, five years in prison for each count of making a false statement related to a health care program, and 20 years in prison for each count of obstruction of justice and each count of wire fraud. The wife also faces five years in prison for each count of obstructing a federal audit. The sentencing of both defendants is presently scheduled for February 1, 2016.
What Can You Do If You Know Someone Who Is Defrauding Medicare Or Medicaid?
There is a federal law known as the False Claims Act that imposes liability on people and companies that defraud federal programs, including Medicare. The False Claims Act includes provisions for private persons (whistleblowers) to file claims on behalf of the U.S. government (a qui tam lawsuit) who may then receive a portion of amounts recovered (typically between 15 % to 25%).
Some medical malpractice lawyers also handle claims under the False Claims Act. By bringing a claim under the False Claims Act, you may not only benefit by receiving a portion of the amount that the government receives but you may also benefit all taxpayers.
Visit our website or call us toll free at 800-295-3959 in the United States if you wish to discuss a possible claim under the False Claims Act.
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