Thursday, January 26, 2012

Karen Rayburn Pleads Guilty in Health Care Fraud Scheme


WASHINGTON—A Baton Rouge, Louisiana-area resident pleaded guilty today for her role in a Medicare fraud scheme involving fraudulent claims for medically unnecessary health care equipment, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS), and the Louisiana State Attorney General’s Office.

Karen Rayburn, 47, pleaded guilty before U.S. District Judge James J. Brady of the Middle District of Louisiana to one count of conspiracy to commit health care fraud.

Rayburn admitted that she worked as a recruiter for Healthcare 1 LLC and Medical 1 Patient Services LLC, Louisiana-based companies that fraudulently billed medical equipment to the Medicare program from 2004 to 2009. She and other recruiters were hired to obtain prescriptions for medical equipment such as leg braces, arm braces, power wheel chairs, and wheel chair accessories. Rayburn obtained information from Medicare beneficiaries and approached their physicians to request prescriptions for medical equipment. Rayburn admitted that when patients’ physicians were unwilling to provide medically unnecessary prescriptions, she and other recruiters asked unrelated physicians to write prescriptions based on cursory examinations of the patients. Another technique they used was to generate photocopied forms with reproduced physicians’ signatures. These prescriptions were then used to submit fraudulent claims to the Medicare program.

From 2004 to 2009, Medicare was billed $6.53 million for the beneficiaries that Rayburn provided as part of this fraudulent scheme.

Rayburn faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been set.

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