Allegiant Experts
Feb 28, 20192 min
Health care fraud is a real pain in the neck. It robs our nation’s health insurance programs of billions of dollars and puts a very negative stigma on the medical community as a whole. Physicians and other health care providers are called upon to give us care when necessary. Between medications, treatments and surgeries, so much of what the medical profession gives us can literally be life-saving.
You would hope that fraud would be off limits. When you consider just how important it is for us to be able to trust medical professionals, it’s scary to think of just how widespread health care fraud acts go in the United States. A couple from Columbus, Ohio is among the latest to prove that, this week. As reported by the city’s NBC4 staff, Amy M. Kirk and Ryan D. Edney have agreed to plead guilty to charges related to a health care fraud scheme.
According to the report, Kirk was a nurse
practitioner working at Pain Management Consortium of Ohio (PMCO). Edney was
the president of RX Health Solutions, LLC. The two are engaged to be married. Together,
the couple prescribed compound creams to both city employees and first
responders even though they weren’t medically necessary. As you may have
guessed, Kirk and Edney billed Medicaid and other health insurers for these
prescriptions.
As NBC4 reports, the couple’s fraudulent scheme took
place between 2014 and 2017. “Kirk also wrote prescriptions that were based on
false medical conditions,” the news source explains, based on a report from the
Department of Justice, “In some instances, prescriptions were written without
ever meeting or examining the patient or were issued in exchange for kickback
payments…Kirk and Edney would recruit patients for compound pain creams, scar
creams, migraine creams or wellness pills.”
Medicaid, Tricare and private insurance companies
were billed for the phony prescriptions. To extract as much money as possible,
Kirk completed information sheets with false physical exam information and
medical diagnoses. She was paid for each prescription through the kickbacks
sent to either Edney’s company or himself directly. The couple personally
received nearly $350,000 in kickbacks.
Earlier this week, Kirk and Edney agreed to plead
guilty to one count of conspiring to commit health care fraud. It’s a crime
punishable by up to 10 years in prison. The two are also expected to pay $750,000
in restitution.
Benjamin C. Glassman is the United States Attorney
for the Southern District of Ohio. “It was part of the conspiracy that the
defendants targeted city employees, including police officers, firefighters and
teachers, because the government insurance programs were more inclined to pay
for compound creams,” he is quoted as saying in the NBC4 report, “Medications
were typically prescribed with 11 refills to maximize reimbursement from the
health care benefit programs and were shipped directly to patients.”
If so, please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help you. Call us at 407-217-5831 or email us at info@allegiantexperts.com.
#nursepractitioner #Columbus #kickbacks #scheme #Ohio #healthcarefraud #Fraud #compoundcreams