Cheyenne Man Ordered To Pay Restitution In Medicare Fraud Case
A Cheyenne man on Monday was sentenced to three years probation and ordered to pay $83,497.31 restitution for defrauding Medicare, according to federal court records.
Brian Jimenez was charged with one count of health care fraud in October, was initially detained and then released on $20,000 bond.
Jiminez pleaded guilty in U.S. District Court in Cheyenne on Dec. 15.
According to the criminal complaint, Jimenez was the owner of Indulge, a company that employed physical therapists and physical therapy assistants.
The employees provided services to patients included Medicare beneficiaries, and billed Medicare for these services under Medicare Part B. Medicare is the federal health insurance program for people 65 and older.
Medicare does not pay for the services of physical therapy assistants in private practices unless they are directly supervised by a licensed physical therapist.
But from May 2012 to February 2014, Indulge billed $269,501.02 to Medicare, which paid $83,497.31 to the company when it did not employ a licensed physical therapist or when no physical therapist was working on the dates of services it allegedly provided.
Jimenez was on notice about the Medicare requirements, but disregarded his employees' concerns, saying the rules did not apply to Indulge or its employees because they were "rural providers" in Wyoming.
A physical therapist who had worked for Indulge notified the fraud hotline of the U.S. Department of Health and Human Services' Office of Inspector General. Indulge continued to bill Medicare using her name even after she quit.
Government agents interviewed her and other former employees.
Two employees also had filed complaints with the Wyoming Board of Physical Therapy. The board's executive director JoAnn Reid told an FBI agent that Jimenez never contacted the board's Profession Licensing Administration her agency about Medicare rules.