Nelson County Drug Store Owner Guilty of Health Care Fraud and Wire Fraud
Crume Drug Store Owner Billed Private Insurance Companies and Medicare Part D for Fraudulent Prescriptions Causing a Combined Loss of $250,188.72
|U.S. Attorney’s Office March 20, 2013|
LOUISVILLE, KY—The owner of Crume Drug Store, located in Nelson County, Kentucky, pleaded guilty in federal court today before Magistrate Judge James D. Moyer to a two-count federal information, charging Timothy Sizemore with health care fraud and wire fraud, announced David J. Hale, United States Attorney for the Western District of Kentucky.
“Sizemore’s submission of fictitious claims for prescription drugs was simple, direct, outright theft from Medicare and private health insurers,” stated U.S. Attorney Hale. “This sort of fraud hurts every person in this country by contributing to the escalating costs of health care. My office is committed to prosecuting those who commit health care fraud and recovering restitution whenever possible.”
According to the plea agreement, Sizemore, age 37, of Bardstown, Kentucky, purchased Crume Drug Store in March 2010 and then, between April 2010 and February 2012, knowingly devised and executed a scheme to defraud Anthem and other private health insurance providers and Medicare Part D. Specifically, Sizemore created false names and placed them under his own Anthem policy number, created fraudulent prescriptions under those names, and billed Anthem for those fraudulent prescriptions, even though they were never actually filled. Also, Sizemore created fraudulent prescriptions using the names of Crume customers and local doctors and billed the customers’ private insurance companies for those prescriptions even though they were never filled. This caused a loss of $154,112.33 to Anthem and private health care insurers. Further, during the same time period, Sizemore admits that he used the names of Crume customers and local doctors to create fraudulent prescriptions and billed Medicare Part D for those fraudulent prescriptions, which were never filled, causing the loss of $96,076.39 to Medicare Part D.
At sentencing, Sizemore could face no more than 30 years in prison, a fine of $500,000, and three years of supervised release. The plea agreement requires Sizemore to pay full restitution on or before May 3, 2013. Sentencing is scheduled before Chief District Judge Joseph H. McKinley, Jr. on July 1, 2013, at 11 a.m. in Louisville.
This case is being prosecuted by Assistant United States Attorney David Weiser and is being investigated by the Federal Bureau of Investigation (FBI) and U.S. Department of Health and Human Services Office of Inspector General.