Doctor Gets Prison for Medicare Fraud Scheme

The Redford Township, Michigan, doctor, a 69-year-old woman, picked up some extra cash, a lot of it, by referring Medicare beneficiaries for home health care services that were medically unnecessary or never provided.

The U.S. Justice Department rightly calls that health care fraud.

The doctor also prepared phony documents to support the fraudulent Medicare claims.

According to her admissions, Paula Williamson signed referrals for a home health care agency known as AMB Healthcare Inc., located in Farmington Hills, Michigan. The owner was in on the plot. AMB needed a physician’s referral to bill Medicare for purported home health care services. Williamson admitted that, at the request of her co-conspirators, including the owner of AMB, she faked medical documents and certified Medicare beneficiaries as home bound — a requirement for Medicare reimbursement — when, in fact, she had never examined or even met the beneficiaries, and they were not home bound.

AMB used the phony paperwork to support bogus claims to Medicare.

Between April 2009 and December 2012, Medicare paid AMB approximately $2.1 million for purported home health care services. Of that amount, approximately $1.3 million was based on Williamson’s false home health referrals.

Williamson was sentenced to 15 months in prison and ordered to pay $1,343,261.61 in restitution.

In other health care fraud cases:

  • A doctor in Ridgefield, Connecticut, admitted that he defrauded Medicare and several private health insurance companies by submitting claims for osteopathic and physical therapy services that he didn’t perform . David Lester Johnston, 46, pleaded guilty to charges in federal court. He is the operator of Osteopathic Wellness Center. Johnston agreed that he made claims in connection with services rendered by a massage therapist, but falsely described the services rendered and falsely stated that he himself had rendered the services. Johnston is scheduled to be sentenced in April 2015. He faces a maximum prison term of 10 years. He will pay $270,528 to settle civil claims resulting from his conduct.
  • The owner and operator of physical therapy rehabilitation facilities was sentenced in Tampa, Florida, to 11 years in prison for organizing a $28.3 million Medicare fraud scheme involving physical and occupational therapy services. Luis Duluc, 54, of Tampa, admitted that he and his co-conspirators used the therapy clinics and other businesses throughout Florida to submit approximately $28,347,065 in fraudulent reimbursement claims to Medicare between 2005 and 2009. Medicare paid approximately $14,424,865 on those claims.

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