Everyone knows medical billing is complicated. With multiple providers of medical services and insurance reimbursement issues, there are often lots of checks involved.
Recently, an employee of a Missouri healthcare company was convicted of fraud in a medical billing scheme. The employee was a 46-year-old woman from St. Peters who worked as a supervisor for a company that contracted to handle billing for SSM Health Care.
The scheme involved submitting false check request forms to SSM. Those forms caused SSM to generate more than $100,000 in refund checks for nonexistent patients, prosecutors contended. After receiving the checks, the woman had deposited them in various personal accounts.
The scheme was detected, however, and the woman pleaded guilty in September to bank fraud charges. Last week, a federal judge in St. Louis sentenced her to 37 months in prison. The judge also ordered the woman to make restitution in the amount of $135,727.95.
Cases of fraud like this are forms of white-collar crime. In general, the U.S. Justice Department has made it clear that investigating and prosecuting financial crimes will be a high priority for the department. This enforcement effort does not only include criminal prosecutions. It also includes civil cases involving such activities as securities trading and money laundering.
Regardless of whether an investigation is primarily civil or criminal, it makes sense for someone who is aware of being a target to protect his or her rights. This may include talking with an experienced criminal defense attorney, even if no charges have been filed.
Source: “St. Peters woman admits stealing $100k from health care company,” St. Louis Post-Dispatch, Robert Patrick, 12-27-12
Our firm handles situations similar to those discussed in this post. To learn more about our practice, please visit our St. Louis white-collar crime defense page.