Monongahela Man Charged in Health Care Fraud Scheme

PITTSBURGH, PA—A resident of Monongahela, Pa., has been charged in Pittsburgh on a charge of health care fraud, United States Attorney David J. Hickton announced today.

The one-count indictment, unsealed today, named Randall F. Guzik, 46, as a defendant.

According to indictment, from January 2007, to May 17, 2011, in the Pittsburgh area, Guzik defrauded two health care benefit programs, that is, Highmark Blue Cross and Blue Shield, a health insurer serving western Pennsylvania (hereinafter Highmark), and Anthem Blue Cross and Blue Shield, a health insurer serving Ohio and Kentucky (hereinafter Anthem), out of approximately $550,077.22.

Guzik prepared billings to Anthem for Highmark insureds residing in Western Pennsylvania for health care services such as conventional joint x-rays that were false in that no conventional joint x-rays were provided, the dates of the services were fabricated, the services were not provided in the locations represented on the billings, and the health care providers listed on the billings did not perform the services.

The law provides for a maximum total sentence of not more than ten years in prison, a fine of $250,000, 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 defendant.

Assistant United States Attorney Nelson P. Cohen is prosecuting this case on behalf of the government.

The Federal Bureau of Investigation conducted the investigation leading to the indictment in this case.

An indictment or information is an accusation. A defendant is presumed innocent unless and until proven guilty.