Corporate Vice President Sentenced for Health Care Fraud Scheme
ATLANTA—Daniel K. Lane, Jr. has been sentenced for conspiring to commit healthcare fraud by filing fraudulent claims with Medicare, Blue Cross Blue Shield, and other insurers.
“This healthcare fraud scheme reached all the way up to the Vice President of Compass Healthcare,” said United States Attorney Sally Quillian Yates. “While serving as Vice President and CFO, the defendant set up the business to automatically bill insurance companies for expensive medical equipment never provided to customers, and then forged prescriptions to make the claims look legitimate. Corporate executives who engage in healthcare fraud face federal prison.”
J. Britt Johnson, Special Agent in Charge, FBI Atlanta Field Office, stated: “Mr. Lane’s criminal conduct was driven by personal greed and today’s sentencing will not only hold him accountable for those actions but will serve as a reminder to others that the FBI and its law enforcement partners will identify, investigate, and present for prosecution those individuals involved in similar such activities.”
“Today’s sentence demonstrates that regardless of one’s position within a corporation, if you defraud Medicare you will be held accountable,” said Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services, Office of Inspector General, Atlanta Regional Office. “Falsifying patients’ medical files in order to generate more corporate revenue at tax payers’ expense will not be tolerated and we will vigorously pursue all such cases.”
According to United States Attorney Yates, the charges and other information presented in court: Daniel K. Lane, Jr. was the Vice President and Chief Financial Officer for Compass Healthcare, Inc., a durable medical equipment business headquartered in St. Louis, Mo., with offices in Atlanta, Ga. and other cities. Compass Healthcare specializes in providing compression stockings to patients who have been diagnosed with medical conditions such as chronic venous insufficiency and edema. Doctors may prescribe compression stockings, which come in different levels of tightness, as treatment for these conditions.
Lane’s position included the responsibility for billing insurance companies for the compression stockings that Compass Healthcare provided to individuals who were covered by insurance. He fraudulently set up the company’s billing system so that in most instances it would automatically bill the insurers for the highest compression stocking, regardless of which stocking had actually been provided to the individual, in order to generate higher payments from Medicare, Blue Cross, and other insurers. As a result, Compass Healthcare routinely “upcoded” the claims it submitted to insurers for the stockings it had provided to individuals.
Lane conspired with an Office Manager for Compass Healthcare, Holly Keisker, and others, to submit these false claims and conceal the fraudulent upcoding. Also as part of the scheme, Compass Healthcare included false diagnoses on its insurance claims to ensure payment. These false claims represented that Compass Healthcare customers had been diagnosed with various medical conditions, including chronic venous insufficiency and edema, to support the claims for high compression stockings, when in fact the customers had not been diagnosed by a doctor. Instead, Compass Healthcare used “blanket” diagnosis codes that were false to support insurance claims for compression stockings provided to customers who had no medical condition. Lane, Keisker, and others conspired to forge and alter doctors’ prescriptions so that they would support the fraudulent claims that had been submitted to insurers. They altered the prescriptions to falsely reflect that a high compression stocking had been prescribed and that the patient had been diagnosed with a medical condition. In 2011, Lane submitted altered prescriptions to Blue Cross in response to an audit conducted by the insurer.
Lane, 57, of St. Louis, Mo., was sentenced by United States District Judge Willis B. Hunt, Jr. to one year and six months in federal prison and three years of supervised release, 100 hours of community service, and ordered to pay $597,304.76 in restitution. On August 27, 2014, Lane pleaded guilty to one count of conspiracy to commit healthcare fraud.
On September 19, 2013, Keisker, 62, also of St. Louis, Mo., pleaded guilty to one count of conspiracy to commit healthcare fraud. Her sentencing is scheduled for December 10, 2014, at 10 a.m., before Judge Hunt.
This case was investigated by Special Agents of the Federal Bureau of Investigation and the U.S. Department of Health and Human Services, Office of the Inspector General.
Assistant United States Attorneys Stephen H. McClain and Jeffrey W. Davis prosecuted the case.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.Presseemail@example.com or (404) 581-6016. The Internet address for the home page for the U.S. Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan.