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Sewickley Woman Charged in $400,000 Medicare Scam
A 62-year-old Sewickley woman has been indicted on charges of health care fraud, accused of bilking Medicare out of nearly $400,000. Mary Monica Wilson-Lefler was named in a one-count indictment unsealed today by United States Attorney David J. Hickton.
According to the indictment, Wilson-Lefler was a salesperson who offered two durable medical equipment companies in the Pittsburgh area a business arrangement involving special air mattresses, known as powered pressure reducing mattresses or PPRAMS. PPRAMS are designed to reduce serious skin ulcers on patients who are essentially bedridden.
Wilson-Lefler visited long-term care facilities to find patients and handled all of the paperwork necessary to enable the DME companies to bill Highmark Blue Cross/Blue Shield’s Security Blue Medicare Program (Security Blue). In order to qualify for Medicare coverage for these PPRAMS, a doctor must order the item in writing. In this case, Wilson-Lefler prepared and sent by fax to attending physicians requests for orders for the PPRAMS.
The faxed information included patient skin condition reports that falsely reported that the patients all had serious skin ulcers. Some of the these patient skin condition reports contained forged signatures of the LTC staff and some had forged signatures of physicians. In reality, none of the patients had serious skin ulcers or any other qualifying conditions that would meet the Medicare coverage requirements.
There were about 83 patients from four facilities in whose names the false claims were made. The total billed was approximately $400,000, and the total paid to the two DME companies was about $200,000.
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 leading to the indictment in this case.
Wilson-Lefler’s indictment is an accusation. A defendant is presumed innocent unless and until proven guilty. If convicted, she faces a maximum sentence of 10 years in prison and a $250,000 fine or both.
Key Facts
- State: Pennsylvania
- Category: White Collar Crime|Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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