Texas Woman Convicted in Federal Court of Health Care Fraud, Including Several Conspiracy Counts

Medical_Care_Card_USA_Sample.JPGA jury in a federal court convicted a Texas woman on multiple fraud-related charges, including health care fraud and conspiracy to commit health care fraud. The government accused the woman and a co-defendant of a scheme to defraud Medicare, Medicaid, and Social Security. United States v. Nowlin, et al, No. 4:12-cr-00730, indictment (S.D. Tex., Nov. 28, 2012). The indictment includes counts for actual fraud offenses and conspiracy to commit various fraud offenses. This is a common tactic among prosecutors, since the elements required to prove conspiracy may be less burdensome than those for fraud. Under some federal laws, the penalties for conspiracy to commit an offense are not that different from the penalties for the actual offense.

The defendant owned two durable medical equipment (DME) supply companies in Bryan, Texas. Both companies were approved suppliers in the Medicare and Medicaid programs. According to the government’s indictment, the defendant, along with a co-defendant, engaged in a scheme from 2003 to 2009 that involved submitting claims for reimbursement to both programs, allegedly in exchange for illegal kickbacks, for equipment that neither doctors nor patients requested nor needed, and that in many cases was never delivered. The total amount of claims reportedly exceeded $3.3 million, and the two defendants received just over $1.1 million from Medicare and Medicaid.

The indictment listed seven counts, including four counts of health care fraud under 18 U.S.C. § 1347, and one count of Social Security fraud under 18 U.S.C. § 641. The remaining two counts were both for conspiracy, citing 18 U.S.C. § 371: conspiracy to commit health care fraud, and conspiracy to violate the anti-kickback statute found in 42 U.S.C. § 1320b-7b.

The federal criminal offense of “conspiracy” requires the government to prove that two or more people, including the defendant, planned to commit an act defined as an offense under federal law, and that at least one participant performed “any act to effect the object of the conspiracy.” 18 U.S.C. § 371. It therefore does not necessarily require proof of any of the elements of the underlying offense, but merely the intent and planning to commit the offense, and some step towards doing so. Any member of the conspiracy may be charged, even if they did not personally take any specific action to further the conspiracy.

If the underlying offense in a conspiracy charge is a felony under federal law, the maximum penalty is five years’ imprisonment. A conviction for health care fraud could result in a prison sentence of ten to twenty years, while a violation of the anti-kickback statute, as cited in the indictment, could result in up to five years in prison. 42 U.S.C. § 1320-7b(b)(2). The jury convicted the defendant in the present case on all seven counts, so she faces sentencing for conspiracy and other offenses.

Defendants in criminal cases have rights protected by the U.S. Constitution, federal and state law, and court procedural rules. They should consult with an experienced criminal defense attorney in order to ensure that those rights are recognized and protected. Criminal defense attorney Michael J. Brown has fought for west Texas defendants for over twenty years. To schedule a confidential consultation to discuss your case, contact us today online or at (432) 687-5157.

Web Resources:

United States v. Nowlin, et al (PACER registration required), No. 4:12-cr-00730, U.S. District Court, Souther District of Texas
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Photo credit: By http://www.medicare.gov [Public domain], via Wikimedia Commons.