Conspiracy to commit healthcare fraud is a criminal offense. It is defined as an agreement that takes between two or more individuals to defraud a healthcare benefit program and/or a healthcare insurance provider. Although there are many ways to commit this crime, it typically involves healthcare professionals, providers, or individuals who seek to obtain financial benefits by submitting false or fraudulent claims for healthcare services or products.
There are generally three elements of conspiracy to commit healthcare fraud. They are an agreement, intent and an overt act. After agreeing to work together to carry out fraudulent activities, the individuals involved must intend to commit the offense. Once an overt act is taken to further the conspiracy (for example, submitting a false claim), health care fraud has occurred. The crime is a serious offense that is punishable under federal and state laws.
Wyoming nurse practitioner pleads guilty to conspiracy to commit health care fraud in Idaho.
This past Monday, the District of Idaho branch of the U.S. Attorney's Office reported that 40 year-old, Kristen Bolling pleaded guilty to conspiracy to commit health care fraud in Idaho. Court documents showed that between April 2017 and October 2019, the nurse practitioner conspired to commit health care fraud.
“Bolling accepted pre-filled medical orders from companies, signing the orders without seeing the patients or making a medical necessity determination and returning the signed orders to the companies in exchange for compensation,” details the report, “During this time, Bolling was licensed and practiced as a nurse practitioner in Idaho. She was also licensed in Wyoming, Colorado, and Washington.”
Bolling was recruited to work for multiple companies.
The companies enlisted Bolling to generate fraudulent medical orders for durable medical equipment (DME). They included braces and cancer genomic testing (CGx). For her role in the scheme, Bolling received kickbacks of approximately $15-$30 per “consult” performed. The expectation was that a “consult” would result in a signed medical order. Bolling’s participation in the conspiracy earned her about $204,007 in kickbacks.
The companies that recruited Bolling used the bogus medical orders she signed to fraudulently bill Medicare. This resulted in payments of over $6.1 million for DME and CGx tests. None of the pieces of equipment or tests were medically necessary. As well, each medical order was procured through the payment of kickbacks and bribes.
Bolling is scheduled to be sentenced on January 9, 2024.
For her crimes, she faces a maximum penalty of 10 years in federal prison. The sentence will be determined by a federal district court judge after considering the U.S. Sentencing Guidelines and other statutory factors. Monday’s announcement of Bolling’s guilty plea was made by U.S. Attorney Josh Hurwit.
“Ensuring the integrity of Medicare and other federal health care programs is a priority for my office,” he is quoted as saying in the U.S. Attorney’s Office report, “It’s about protecting taxpayer funds and, ultimately, patient well-being. We will continue to hold accountable anyone who engages in illegal kickback schemes like the one uncovered through this investigation.”
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