A former pain clinic owner and a medical sales representative were sentenced for their role in a healthcare fraud scheme.
David Lyle Shehi owned Etowah Pain in Rainbow City, Ala. There he was paid kickbacks in exchange for ordering nerve conduction tests from QBR, an electro-diagnostic testing company, that would be billed to Medicare and other health insurance programs, according to a March 21 news release from the Justice Department. At his practice, Dr. Shehi routinely billed health insurance programs for patient visits using the code that would receive the highest reimbursement.
James Ewing Ray, a medical sales representative from Gadsden, Ala., marketed various healthcare products and services to physicians' offices. He was paid for the prescriptions, durable medical equipment, and tests he generated from physicians.
Mr. Ray conspired to pay and receive kickbacks to persuade medical providers to issue and order medically unnecessary prescriptions, goods and services, which were billed to Medicare and other health insurers, according to the release. He received per-patient kickbacks from QBR for convincing medical providers to order tests from QBR.
Mr. Shehi was sentenced to 28 months for conspiracy to commit healthcare fraud. He was also ordered to pay forfeiture and restitution to his victims.
Mr. Ray was sentenced to 40 months for conspiracy to commit healthcare fraud. He was also ordered to forfeit more than $850,000 and to pay restitution to victims of more than $5.3 million.