U.S. Attorney's Office
Western District of Pennsylvania
October 31, 2014

Sewickley Woman Sentenced to 15 Months in Prison for Health Care Fraud

PITTSBURGH—An Allegheny County resident has been sentenced in federal court to 15 months in prison on her conviction of health care fraud, United States Attorney David J. Hickton announced today.

United States District Judge Mark Hornak imposed the sentence on Mary Monica Wilson-Lefler, 64, of Sewickley, PA.

According to the information presented to the court, Wilson-Lefler was a salesperson who offered two durable medical equipment companies in the Pittsburgh area a business arrangement involving special air mattresses, known as powered pressure reducing mattresses or PPRAMS. PPRAMS are designed to reduce serious skin ulcers on patients who are essentially bedridden. She visited long term care (LTC) facilities to find patients, and handled all of the paperwork necessary to enable the DME companies to bill Highmark Blue Cross/Blue Shield’s Security Blue Medicare Program. In order to qualify for Medicare coverage for these PPRAMS, a doctor must order the item in writing. In this case, Wilson-Lefler prepared and sent by fax to attending physicians requests for orders for the PPRAMS. The faxed information included patient skin condition reports that falsely reported that the patients all had serious skin ulcers. Some of these patient skin condition reports contained forged signatures of the LTC staff and some had forged signatures of physicians. In reality, none of the patients had serious skin ulcers or any other qualifying conditions that would meet the Medicare coverage requirements. There were about 83 patients from four facilities in whose names the false claims were made. The total billed was approximately $400,000, and the total paid to the two DME companies was about $200,000.

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

U.S. Attorney Hickton commended the Federal Bureau of Investigation and the United States Food and Drug Administration-Office of Criminal Investigations, for the investigation leading to the successful prosecution of Mary Monica Wilson-Lefler.

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