A Baton Rouge, Louisiana judge is sending two area women to jail for their participation in a durable medical equipment (DME) health care fraud scheme.
Chief U.S. District Court Judge Brian A. Jackson sentenced Eunice Sparrow on June 20th to 14 months and Uniecesco Smith on June 25th to 12 months and 1 day in prison for their roles in a two-year DME health care fraud scheme. Each was ordered to serve a term of supervised release following her release from imprisonment, and to make restitution to the United States Department of Health & Human Services. Smith was also ordered to pay a $7,500 fine.
The sentences were imposed based on the guilty pleas that Smith and Sparrow previously entered on February 22, 2012, to several counts of health care fraud. In their plea agreements, the defendants admitted that they knowingly aided and abetted a health care fraud scheme perpetrated by their co-defendant, Linda M. Jackson.
From April of 2007 through April of 2009, Jackson used Plaquemine, Louisiana DME company, A&A Durable Medical Supply, to defraud Medicare by submitting false reimbursement claims to Medicare for items that the company had never provided. In their plea agreements, Sparrow and Smith admitted that they helped Jackson by completing and signing false delivery tickets and other fraudulent documents at Jackson’s direction. A&A kept the fraudulent documents in its patient files in an attempt to substantiate the fraudulent claims Jackson submitted to Medicare. Jackson later provided the false documents to an auditor who requested the patient files in the course of an investigation into A&A’s claims. Jackson is awaiting sentencing.
Health Care Providers Must Act To Manage Risks
The Smith and Sparrow convictions and sentencing reflect the tightening enforcement federal health care fraud laws. In response to the growing emphasis and effectiveness of Federal officials in investigating and taking action against health care providers and organizations, health care providers covered by federal false claims, referral, kickback and other health care fraud laws should consider auditing the adequacy of existing practices, tightening training, oversight and controls on billing and other regulated conduct, reaffirming their commitment to compliance to workforce members and constituents and taking other proper steps to help prevent, detect and timely redress health care fraud exposures within their organization and to position their organization to respond and defend against potential investigations or charges. In light of the growing qui tam risks, health care providers also should tighten internal investigation, exit interview and other human resources and business partner oversight, reporting and investigation policies and practices to help identify and redress potential fraud or other qui tam, retaliation and similar exposures early and more effectively.
For More Information Or Assistance
If you need assistance reviewing or responding to these or other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health industry clients about these and other matters. Her experience includes advising hospitals, nursing home, home health, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies; prevent, conduct and investigate, and respond to peer review and other quality concerns; and to respond to Board of Medicine, Department of Aging & Disability, Drug Enforcement Agency, OCR Privacy and Civil Rights, HHS, DOD and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.
A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications. You can get more information about her health industry experience here. If you need assistance responding to concerns about the matters discussed in this publication or other health care concerns, wish to obtain information about arranging for training or presentations by Ms. Stamer, wish to suggest a topic for a future program or update, or wish to request other information or materials, please contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
If you or someone else you know would like to receive future updates about developments on these and other concerns from Ms. Stamer, see here.
About Solutions Law Press
Solutions Law Press™ provides business risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources including:
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©2012 Cynthia Marcotte Stamer, P.C. Non-exclusive license to republish granted to Solutions Law Press. All other rights reserved.
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