Nelson County Drug Store Owner Sentenced to 27 Months for 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 $242,963.04
|U.S. Attorney’s Office October 01, 2013|
LOUISVILLE, KY—The owner of Crume Drug Store, located in Nelson County, Kentucky, was sentenced in federal court today, by Chief Judge Joseph McKinley, to 27 months in prison, followed by a two-year term of supervised release, and was ordered to pay $242,963.04 in restitution, announced David J. Hale, United States Attorney for the Western District of Kentucky. There is no parole in the federal system.
Timothy Lee Sizemore, age 37, of Bardstown, Kentucky, was charged by information on February 27, 2013, with one count of health care fraud and one count of wire fraud. According to information presented in court, Sizemore purchased Crume Drug Store in March 2010, and then, between April 2010 and February 2012, Sizemore devised and executed a scheme to defraud Anthem and other private health insurance providers and Medicare Part D.
Sizemore pleaded guilty as charged on March 20, 2013. Sizemore admitted that he 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. During the same time period, Sizemore admitted 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. As part of his plea agreement, Sizemore paid full restitution of $242,963.04 prior to his sentencing hearing.
This case was prosecuted by Assistant United States Attorney David Weiser and was investigated by the Federal Bureau of Investigation (FBI) and U.S. Department of Health and Human Services, Office of the Inspector General.