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.
The fraud scheme involved compound creams.
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.”
The couple caused more than $751,000 in fraudulent insurance claims.
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.”
Are you an attorney currently trying a health care fraud case?
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