A man using the address of a Tennessee barn as an office after stealing a doctor’s identity to bill Medicare was sentenced to more than five-and-a-half years in prison Feb. 15.
Yennier Capote Gonzalez was convicted of five counts of healthcare fraud, two counts of aggravated identity theft and one count of money laundering. He also has to pay $19,296 in restitution, according to the U.S. Attorney’s Office in the middle district of Tennessee.
The HHS Office of Inspector General (OIG) was notified of an attempt to transfer $17,000 from a Tennessee account of Gainesboro Ultimate Med Service that had just received $38,000 from Medicare, the U.S. Attorney’s Office stated. When OIG visited the address of the business, investigators found “an old barn and an uncompleted house at another tract of land that was used as the address for fraudulently billed patients,” the U.S. Attorney’s Office stated.
Further investigation showed that Gainesboro Ultimate Med Service stole the identity of a Knoxville, Tenn., doctor, used it to get a Medicare provider number at the barn address then submitted claims for South Florida patients who were also victims of identity theft, the U.S. Attorney’s Office stated.
For more information on the case, visit: http://www.justice.gov/usao/tnm/pressReleases/2013/2-19-13.html.
In unrelated cases:
- Illinois doctor faces up to 10 years in prison for obstructing a criminal health care fraud investigator. Mahmoud Yassin pleaded guilty to the charge and is scheduled for sentencing May 30, according to the U.S. Attorney’s Office in southern Illinois. Yassin allegedly altered a progress note to show an in-office exam that had not taken place after an FBI agent subpoenaed patient records. Yassin also faces a fine of up to $250,000, a special assessment of $100 and up to three years of supervised release after prison, the U.S. Attorney’s Office stated. For more on this case, visit http://www.justice.gov/usao/ils/News/2013/Feb/02142013_Yassin%20Press%20Release.html.
- Optometrist pleads guilty to submitting more than $800,000 in fraudulent claims to Medicare. Jeffrey Sponseller of Augusta, Ga., billed Medicare claiming that he saw 177 patients for 45 minutes each during a one-day visit, according to the U.S. Attorney’s Office in southern Georgia. That resulted in Medicare paying Sponseller for that type of eye exam more than any other doctor in the country in 2009, the U.S. Attorney’s office states. Sponseller faces five years in prison, a fine of up to $250,000 and repayment of restitution. For more on this case, visit http://www.justice.gov/usao/gas/pr/2013/20130220_Sponseller.html.
Recovery auditors (RACs) did not post new issues last week.
About the Author
Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.
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