Policy & Regulation News

June 5: Week That Was in Healthcare Fraud and Malpractice

By Jacqueline DiChiara

- Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.

Healthcare fraud

Ohio medical provider steals credit card information

Teresa Lewis was sentenced this week to a year and a day in federal prison for defrauding her place of employment, the Huntington Retina Center, a medical center for vision disorders, eye injuries, and eye diseases. Lewis, who worked as a billing assistant there, gained access to credit cards. She subsequently made over $52,000 in unauthorized personal purchases. Lewis pleaded guilty in March to a pair of felony counts of access device fraud. She will repay over $52,000 to the Huntington Retina Center.

CA man obtains controlled substance via Medicaid fraud

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  • Michael James Lott pleaded guilty this week to acquiring and obtaining a controlled substance via Medicaid fraud. Lott admitted to filling prescriptions ahead of schedule and forging prescriptions.

    Last year, Lott filled a pretend prescription for Oxycodone before submitting the forged prescription for Medicaid payment. Lott additionally pleaded guilty to misrepresentation, fraud, deception, and false statement.

    $2.5M fraud, FL healthcare provider sentenced to 75 months

    Ankur Roy, former owner and operator of a provider of outpatient physician and respiratory therapy, Selectcare Health, Inc, was sentenced to 75 months in federal prison this week for involvement in a $2.5 million healthcare fraud scheme.

    Roy, convicted of 5 counts of the indictment in July of last year, will serve an additional 3 years of supervision following his release and will forfeit over $2.5 million in proceeds gained by defrauding both Medicare and Blue Cross Blue Shield of Illinois. Also charged were Dipen Desai, sentenced to 27 months, and Akash Patel, scheduled to be sentenced next month.

    Along with the assistance of his co-defendants, Roy submitted false and fraudulent health insurance claim forms to Medicare and Blue Cross Blue Shield for services he knew had never been provided for alleged respiratory services. Roy reportedly executed this scheme to hinder red flags with established fraud detection systems. $600,000 of the collected sum was spent on a plethora of personal expenses, including paying off student loan debt and paying off credit card bills.

    “Defendant Roy’s fraud deprived Medicare and Blue Cross Blue Shield of over $2.5 million, a substantial sum of money that should have gone to pay for medical services for senior citizens, and not to line his and his partners’ pockets,” states Assistant Attorney Maureen Merin at the sentencing.

    Lott faces possible charges of up to 4 years in prison and a possible fine of up to $250,000 with 1 year of supervised release for acquiring and obtaining a controlled substance illegally.