2 ambulance company owners sentenced in $10.8M Medicare fraud
The case is one of the largest Medicare ambulance fraud cases ever prosecuted by the U.S. Department of Justice
By Laura French
GUAM — Two owners of an ambulance company in the United States territory of Guam have been sentenced to prison terms for their roles in a $10.8 million Medicare fraud scheme.
The U.S. Department of Justice said in a statement Tuesday that the case is one of the largest single Medicare ambulance fraud cases ever prosecuted by the department.
Clifford P. Shoemake, 63, one of the owners of Guam Medical Transport, was sentenced to serve 71 months in federal prison, and another owner, Kimberly Clyde "Casey" Conner, 60, was given a sentence of 63 months. Both had pleaded guilty to counts of conspiracy to commit healthcare fraud and conspiracy to engage in monetary transactions with the proceeds of unlawful activity.
Officials say the pair knowingly received Medicare and TRICARE reimbursements for non-emergency transports that were not medically necessary, and took measures to cover up the scheme.
Medicare and TRICARE allow reimbursements for non-emergency transports of beneficiaries to and from dialysis treatments if the ambulance transports are deemed medically necessary due to the patient being bed-confined or unable to be transported any other way without endangering their health.
Investigators found that Guam Medical Transport received millions in reimbursements for transporting dialysis patients who were not bed-confined and did not qualify for medically necessary ambulance transport, and that Shoemake and Conner instructed employees to remove references to patients being able to walk in internal documents.
Shoemake and Conner also admitted to using funds generated by the fraud scheme for personal expenses including vacations, personal residences and personal income taxes, and falsely categorizing those expenses as business expenses, according to the Department of Justice.
In addition to their prison sentences, the defendants were ordered to pay back more than $10.8 million in restitution.