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Former state employee sentenced for health care fraud crime

In 2018, the Department of Justice (DOJ) announced charges against a former state employee for health care fraud violations. The accused waived her right to an indictment and chose to take a plea deal. According to the agreement, the accused confessed to running two social and psychotherapy businesses.

According to the DOJ, the businesses billed for services not provided. The accused stated she and another individual used provider numbers for the billing from providers who had not seen the patients or provided services. The scheme also allegedly involved stealing personal information from Medicaid recipients for future fraudulent billing purposes.

What are the penalties for this type of crime? In this case, based on these facts, the woman faced up to ten years imprisonment and additional financial penalties. As part of the deal, she agreed to pay the government over $2.4 million in restitution and await further sentencing.

A United States Attorney recently stated the accused was sentenced this past week to a two-year prison sentence. The prosecution states the reduced prison sentence is the result of her cooperation during the investigation.

What can others charged by the government with health care fraud learn from this case? The case provides two valuable lessons:

  1. Health care fraud extends beyond medical professionals. Medical professionals are not the only ones who can face allegations of health care fraud. The government can pursue charges against anyone who it claims falsely bills Medicaid or Medicare.
  2. The process is lengthy. Even this relatively straight-forward case took over a year from investigation to charges to sentencing.

Those who face allegations of health care fraud have options to protect their interests. An attorney experienced in this area of the law can review the allegations and work to better ensure your rights are protected.  

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