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Posted on Dec 18, 10:00PM | IBNS
A 40-year-old Houston man, Lawrence T. Tyler, has been indicted on charges of health care fraud and conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced on Monday.
The nine-count indictment, returned December 12, was unsealed on Monday upon his arrest without incident.
The indictment alleges that from 2007 to 2009, Tyler falsely billed Medicare and Medicaid for so-called "ortho kits," which consisted of an assorted of various back, knee, ankle, wrist, and shoulder braces.
Tyler allegedly billed for equipment that was never delivered, billed for equipment using prescriptions from a physician who never treated the patients, and upcoded-billed for a higher reimbursed brace but delivered a cheaper brace that either did not fit the billing code or did not qualify for any Medicare reimbursement.
In addition, as part of the conspiracy, the indictment alleges Tyler paid a marketer for patient billing information, a violation of the federal anti-kickback statute.
Tyler, under the company name, 1866ICPAYDAY.COM LLC, allegedly billed Medicare and Medicaid approximately USD 3 million and was paid approximately USD 1.4 million.
The statutory maximum penalty for a violation of the health care fraud statute is imprisonment of not more than 10 years and a maximum USD 250,000 fine. If convicted of the conspiracy, he also faces up to five five years in prison and another USD 250,000 fine.
The charges are the result of the investigative efforts of the FBI, the Texas Attorney General's Medicaid Fraud Control Unit, Department of Health and Human Services-Office of Inspector General, Office of Investigations, and the United States Attorney's Office. Special Assistant United States Attorney Suzanne Bradley is prosecuting the case.
An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless and until convicted through due process of law.