The United States Department of Justice’s (DOJ) U.S. Attorney’s Office for the Northern District of Texas recently announced the sentencing of a nurse practitioner (NP). The feds had accused the NP, who practiced in Texas, of engaging in a scheme to defraud Medicare and private insurance providers. According to the prosecution, the NP used the provider numbers of six doctors to file false claims with insurance providers.
The feds state the claims were for services never provided and that the NP used a complicated network of wire transfers in an attempt to remove the money from its original source. The DOJ states the NP was responsible for over $55 million in fraudulent claims.
In addition to the claims and wire transfers, the government also says the NP and his staff attempted to put together fraudulent medical records to support the claims and defend against the government’s allegations of healthcare fraud. The U.S. Attorney’s Office then used this evidence to build a case against the NP and pushed the court for an aggressive sentence. The NP ultimately chose to plead guilty to conspiracy to commit wire fraud. The court sentenced him to 20 years of federal imprisonment and ordered him to repay over $52 million.
Special Agent in Charge of the United States Department of Health and Human Services Office of the Inspector General in charge of the investigation stated the harsh sentence should serve as a warning to other healthcare professionals. The feds, she stated, will do “everything possible to root out all forms of waste, fraud and abuse” in healthcare. As a result, medical professionals are wise to take all allegations of healthcare fraud very seriously. Prepare a defense even against those that may seem frivolous or fabricated. Federal enforcement efforts within this sector are unlikely to ease in coming years.