A U.S. District Judge recently sentenced a physician to ten years imprisonment for his role in a fraudulent billing scheme. The sentence also included three years of supervised release and a restitution payment of over $4.2 million.
The case began in 2017 with a whistleblower claim. An individual who worked with the physician alerted the government of a potential violation, which led to an investigation. After this investigation, the government accused the physician false billing for his pain management clinics. Those who bring forward a claim through a whistleblower suit stand to receive a reward if the government is successful with the case. In this case, the whistleblower will get approximately $680,000 of the settlement funds.
The case got a good deal of coverage after the government claimed the physician’s wife, who worked at the clinic as a physical therapist, attempted to burn records to get rid of incriminating evidence. The fire grew out of control and spread to their home. Upon investigation, firefighters at the scene claimed the fire was the result of a large blaze in the outdoor fireplace, which included charred records submitted to the police for further investigation. These charred records were used to help build the case against the physician and his wife.
When facing this evidence, the physician and his wife chose to accept a plea deal. The agreement included a guilty plea to conspiracy to commit healthcare fraud — which can come with 18 to 36 months imprisonment. He also agreed to settle a False Claims Act (FCA) allegation, which led to the larger prison sentence noted above.