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  4.  » Tennessee Health Care Exec Sentenced To 3.5 Years In Federal Prison For Alleged Medicare Kickback Scheme

Tennessee Health Care Exec Sentenced To 3.5 Years In Federal Prison For Alleged Medicare Kickback Scheme

A former health care executive in Tennessee was sentenced to 3-1/2 years in Federal prison last week on a guilty plea for her alleged involvement in a scheme to pay $4.6 million in kickbacks for illicit Medicare referrals.

The 71-year-old woman is accused by prosecutors to have agreed to pay illegal kickbacks to the CEO of a pain management clinic in exchange for providing Medicare referrals for durable medical equipment (DME). Prosecutors say the CEO provided the referrals in exchange for 60 percent of the proceeds derived from Medicare.

In order to obscure the illegal kickbacks, prosecutors say the duo made the payments through a third party, filed false tax documents, and took steps to prevent the pain management clinic from billing Medicare itself.

Prosecutors say the conspiracy hit a new gear in the spring of 2015 when the defendant changed the agreement due to dissatisfaction over the amount of the proceeds she was receiving from Medicare. Prosecutors say she agreed to pay the CEO $200,000 to buy a sham corporation, ultimately paying only $150,000 for the business. The alleged purpose for this sale was to insure the continued participation of the CEO in the alleged kickback scheme.

Altogether the defendant allegedly paid over $770,000 in illegal kickbacks to obtain over $2.9 million in illicit reimbursements from Medicare. The CEO with whom she allegedly conspired was convicted of one count of conspiracy to defraud the United States and to violate the anti-kickback statute, and seven counts of violating the anti-kickback statute. His sentencing is pending.

The defendant pled guilty in January to to one count of conspiracy to violate the anti-kickback statute and seven counts of violating the anti-kickback statute. She was sentenced by U.S. District Judge William Campbell Jr., of the Middle District of Tennessee to 42 months in Federal prison and ordered to forfeit $595,676.80.

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