Medical supply and billing firm executive pleads guilty to fraud
A former executive with a medical supply and billing company in Arkansas pleaded guilty Wednesday to a conspiracy charge in connection with a $3.9 million scheme to defraud the federal government and private insurers by overcharging for unnecessary medications provided to workers compensation patients, the U.S. Attorney’s Office announced.
Amanda Dawn Rains pleaded guilty to one count of conspiracy to commit mail fraud, wire fraud, health care fraud, fraud to obtain federal employees’ compensation and paying kickbacks.
Ms. Rains was hired in 2013 as the billing director for a billing company in Rogers, Arkansas, that was not identified by name in court papers. She joined a fraud scheme that started two years earlier and continued through 2017 that defrauded the federal employee workers compensation program and private comp insurers.
Charging documents allege people working for the unnamed company recruited physicians to dispense pain creams and patches to workers compensation patients in exchange for a share of the profits from successfully billing insurers.
After signing contracts with physicians, the company supplied them with pain creams and patches, and acted as the billing agent for the physicians, handling paperwork and submitting the allegedly fraudulent claims to insurers and the U.S. Department of Labor, Office of Workers’ Compensation Programs, billing them at markups of up to 20 times what the medications actually cost, and then paid the physicians kickbacks on amounts collected.
Ms. Rains was accused of managing the billing system and electronically submitting the fraudulent claims and advising doctors on how to respond to insurers that questioned charges.
Robert Dale Bernauer Sr., who ran a clinic in Lake Charles, Louisiana, pleaded guilty in July to a conspiracy charge for his role in the scheme.
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