November 6: Week That Was in Healthcare Fraud and Malpractice
"Today, the defendant has voluntarily agreed to a five-year prison sentence for his criminal conduct and has chosen to abandon any further challenge to the court’s ruling against him."
By - 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.
Guilty plea in multi-million-dollar fraud scheme
Jacob J. Kilgore, the former owner of a Utah-based durable medical equipment company and former president of Orbit Medical, a durable medical equipment supplier for power wheelchairs, pleaded guilty earlier this week to three counts of conspiracy.
The United States District Court may accept a mandated 60 months in federal prison as per a plea agreement in association with this Medicare fraud scheme.
Says Gerald Roy, Special Agent in Charge of Health and Human Services Office of Inspector General, “This guilty plea is the result of the diligent work and collaborative efforts of several agencies. We will continue to work with our law enforcement partners to investigate those who attempt to cheat the federal health care programs.”
Medical necessity in regard to power wheelchairs billed to Medicare is in primary question regarding this conspiracy act. Kilgore admitted to revising and altering paperwork to falsely verify beneficiaries qualified for a power wheelchair via their Medicare coverage when he knew such was not true.
Kilgore admitted awareness that Medicare requires medical record documentation support and that Medicare can request to review his supporting claim documentation. Kilgore additionally admitted to being well aware that if Medicare requirements were not met, claim denials were indeed possible. Kilgore maintains responsibility for firing sales representatives who did not meet a sales quota of 10 power wheelchairs per month.
“In the United States Attorney’s Office, we take our professional obligations seriously and will not trade our integrity for any case,” says United States Attorney, John W. Huber.
“While upholding the highest ethical standards, my office will aggressively root out white collar fraud and hold law breakers accountable for the damage caused by their greed-driven actions,” Huber adds.
Adds Huber:
Less than a month after the court rejected his motions claiming prosecutorial misconduct, Mr. Kilgore has accepted responsibility for a multi-million-dollar fraud scheme. On October 8, 2015, Chief Judge David Nuffer denied the defense motion to dismiss and to disqualify the prosecution team, finding that the prosecution had not deliberately intruded into privileged attorney-client communications.
Today, the defendant has voluntarily agreed to a five-year prison sentence for his criminal conduct and has chosen to abandon any further challenge to the court’s ruling against him. This development speaks volumes as to the denied claims that federal prosecutors were acting outside their ethical obligations.
