Pittsburgh Woman’s Health Care Fraud Scheme Uncovered
A 63-year-old Sewickley resident has pleaded guilty to a charge of health care fraud, announced United States Attorney David J. Hickton.
Mary Monica Wilson-Lefler, who was a salesperson for two durable medical equipment companies, offered a business arrangement involving special air mattresses, known as powered pressure reducing mattresses or PPRAMS, to long-term care facilities in the Pittsburgh area.
Wilson-Lefler visited these facilities to find patients, handled the paperwork to enable the durable medical equipment companies to bill Highmark Blue Cross/Blue Shield’s Security Blue Medicare Program, and prepared and sent faxed requests to attending physicians for orders of the PPRAMS. However, the requests included patient skin condition reports that falsely claimed the patients had serious skin ulcers, and some of these reports contained forged signatures of the LTC staff and physicians.
In reality, none of the patients had serious skin ulcers or any other qualifying conditions that would meet the Medicare coverage requirements. As a result, false claims were made in the names of about 83 patients from four facilities, totaling approximately $400,000, with the Medicare program paying out about $200,000 to the two DME companies.
United States District Judge Mark Hornak scheduled the sentencing for October 10, 2014. Under the law, Wilson-Lefler faces a maximum sentence of 10 years of incarceration and a $250,000 fine or both. The actual sentence will be determined by the Federal Sentencing Guidelines, taking into account the severity of the offense and Wilson-Lefler’s prior criminal history, if any.
Assistant United States Attorney Nelson P. Cohen is prosecuting this case on behalf of the government. The Federal Bureau of Investigation and the United States Food and Drug Administration-Office of Criminal Investigations conducted the investigation that led to the prosecution of Mary Monica Wilson-Lefler.
RELATED: Healthcare Fraud
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Key Facts
- State: Pennsylvania
- Category: Health Care Fraud
- Source: DOJ Press Release â†â€â€
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