Readers of the Allegiant Experts Blog are well aware that health care fraud comes in all forms. They include kickback schemes, money laundering, false billing and drug distribution among many other illegal activities. Our blog has also shown that health care fraud, in all its forms, takes place all over the country. As well, the crimes are perpetrated by people from all walks of life.
Our blogs highlight many stories of health care fraudsters who have been brought to justice. The majority of them have been men. This isn’t to say, however, that women don’t commit health care fraud. In the past week, two women were among the latest to be found guilty of health care fraud.
Jami L. Mayhew has entered a guilty plea.
As reported by the Southern District of Illinois branch of the United States Department of Justice, the 41-year-old nurse practitioner pleaded guilty to a single count of health care fraud. This past Tuesday, Mayhew admitted to knowingly participating in a scheme to defraud Medicare. It involved performing medically unnecessary visits to nursing homes located in St. Clair and Madison counties.
At the plea hearing, Mayhew established that from May 30 to June 26, 2017, she visited nursing home residents multiple times. She examined them for only a few minutes at a time. Afterward, she created progress notes that she knew contained misrepresentations and materially false statements. Mayhew lied about the services she had performed and falsely reported that her visits met the billing requirements for complex subsequent nursing home encounters.
“As part of her guilty plea, Mayhew admitted that she knowingly caused 251 false claims to be submitted to Medicare during the charged timeframe,” reports the DoJ, “Medicare paid her employer, General Medicine, P.C., over $23,000 for those visits. Mayhew, herself, received $27 from the company for each of the false claims she caused to be submitted, for a total of $6,777.”
Saffron Gustafson has been sentenced to 21 months in prison.
Tax evasion is another form of health care fraud. As the District of Oregon branch of the United States Department of Justice reports, the 43-year-old Gustafson will be spending time in federal prison, in part, for this crime. Last week, the Springfield woman was handed down her sentence for defrauding six health insurance plans of approximately $1.3 million and for evading $99,000 in federal income taxes.
In court last week, Gustafson received her sentence of 21 months in federal prison and three years’ supervised release. She was also ordered to pay more than $1.3 million in restitution to the victim insurance plans.
As the owner and operator of a durable medical equipment company known as Saffron’s Specialized Medical, Gustafson supplied customized compression garments to patients with circulatory medical conditions. Between June 2013 and August 2017, however, she submitted bills requesting payment amounts inflated by 600% or more.
“To support these false billings, Gustafson, and employees acting at her direction, fabricated invoices from her wholesaler,” the DoJ explains, “ Gustafson and her employees destroyed the genuine wholesaler invoices so insurance companies could not review them during audits…Gustafson also evaded $99,606 in income taxes she owed for 2015 by falsifying records and diverting profits from her company.”
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