Health care fraud is any act in which someone commits a deceptive act involving health care for his or her own financial gain. It most often involves doctors or patients providing false information to health insurance companies, but physicians accepting financial incentives from pharmaceutical companies in order to prescribe their drugs also counts as health care fraud, as does writing prescriptions containing false information. It is not only physicians who can be charged with health care fraud; patients and anyone who works in the health care, health insurance, pharmaceutical, or medical devices industry can be guilty of health care fraud if they use their job position or their status as a patient to benefit financially from their dishonesty. In 2017, a court sentenced Dr. Noble Ezukanma, a pulmonologist from Dallas, to 200 months in federal prison for Medicare fraud. Another physician and four office administrators who participated in the fraudulent scheme were also convicted and received sentences.
The Ezukanma Medicare Fraud Case
Dr. Ezukanma and a colleague, Dr. Ransome Etindi, are physicians who oversaw the home health care of Medicare-eligible patients in the Dallas area. Their Medicare fraud scheme involved triple-billing the patients’ care. In other words, a patient would receive one in-home visit from a doctor or other course of home treatment, and the doctors would submit the Medicare claim three times through three different insurance companies. Myrna Parcon, Oliva Padilla, Ben Gaines, and Lita Dejesus operated the home health care companies that participated in the scheme, namely US Physician Home Visits, Be Good Healthcare, and Essence Home Health.
Besides triple-billing for health care services, Dr. Ezukanma also employed other tactics to inflate the costs of the Medicare claims he submitted on behalf of his patients. For example, many of his visits with patients lasted only 15 or 20 minutes, the length of most outpatient physician visits. Dr. Ezukanma, however, would bill Medicare for 90-minute visits, the longest visit for which Medicare has a billing code. By the time the scheme ended, Dr. Ezukanma and his co-conspirators had defrauded Medicare out of some $50 million.
The Defendants’ Sentences
According to Texas law, the maximum penalty for a single count of healthcare fraud is 10 years in prison plus $250,000 in restitution. The defendants in the Ezukanma case sometimes had to pay much more than that because of their multiple counts of fraud and conspiracy to commit fraud. The court required Dejesus, one of the home health care company administrators, to pay more than $4 million in restitution. While Etindi’s prison sentence is only two-and-a-half years, he must pay $18 million, while Parcon, another home health company administrator, must pay $51 million.
Contact Madrid Law About Fraud Cases
While fraud is a nonviolent crime, being convicted of it can still carry a harsh penalty, including long prison sentences. A good defense lawyer can make all the difference in the outcome of your fraud case. Contact Madrid Law in Houston if you are facing charges of fraud or other financial crimes.