Case File #3 Owner/Operator of a Durable Medical Supply Company (DME Supplier) was convicted of 143 counts of healthcare fraud, mail fraud, and paying illegal kickbacks for Medicare referrals. The owner/operator was sentenced to 66 months in federal prison for defrauding Independence Blue Cross and Medicare.

An owner/operator of a Durable Medical Supply company (DME Supplier) was sentenced to 66 months in federal prison for defrauding Independence Blue Cross and Medicare by submitting false and fraudulent claims for DME supplies that were never required nor ordered by the treating physicians. The owner/operator was charged with 48 counts of healthcare fraud, 6 counts of mail fraud, and 47 counts of paying illegal kickbacks for Medicare referrals among others. The owner/operator pled guilty to a total of 143 counts.

It was determined through CFID interviews, that medical equipment for IBC subscribers was never requested and/or received, as well as never ordered and/or authorized by a physician. The DME supplier also billed for medical equipment for deceased and amputee members, as well as, physician and patient signature forgeries on various patient files documentation to include Medical Necessity letters.