September 17, 2013: Sewickley Woman Charged with Health Care Fraud
Food and Drug Administration
Office of Criminal Investigations
U.S. Department of Justice Press Release
For Immediate Release
September 17, 2013
United States Attorney
Western District of Pennsylvania
PITTSBURGH - A Sewickley resident has been indicted by a federal grand jury in Pittsburgh on charges of health care fraud, United States Attorney David J. Hickton announced today.
The one count indictment named Mary Monica Wilson-Lefler, 62, of 103 Compton Road, Sewickley, PA 15143, as the defendant.
According to the indictment, Wilson 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. She visited long term care (LTC) 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 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 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.
The law provides for a maximum sentence of 10 years in prison and a $250,000 fine or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offense and the prior criminal history, if any, of the defendants.
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.
An indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.