The Department of Justice (DOJ) has intervened in a False Claims Act lawsuit against Orbit Medical and Jake Kilgore for allegedly altering and forging physician prescriptions and supporting documentation for power wheelchairs and accessories.
On Oct. 23, 2013, a federal grand jury in Utah indicted Kilgore, former vice president and sales manager, on three counts of healthcare fraud, three counts of false statements related to health care and three counts of wire fraud.
“The government is intervening in this matter seeking to restore Medicare trust funds taken through the alleged use of falsified records and fraudulent billings, among other things,” said U.S. Attorney for the District of Utah David Barlow in a release. “Health care fraud is aggressively pursued in Utah. Every effort is made to restore taxpayers’ dollars taken through fraudulent conduct.”
The DOJ’s intervention illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The initiative is a partnership between the DOJ and the Department of Health and Human Services.
The lawsuit alleges that Orbit Medical sales reps, at Kilgore’s direction and encouragement, knowingly altered physician prescriptions and supporting documentation to get the company’s power wheelchair and accessory claims paid by Medicare. In particular, it alleges that the sales reps created documents to falsely establish that physicians examined beneficiaries in person; changed prescriptions to falsely establish medical necessity; created or altered chart notes and other documents to falsely establish medical necessity; and forged physician signatures on prescriptions and chart notes and added facsimile stamps to supporting documentation.
The allegations against Orbit Medical and Kilgore were filed under the False Claims Act by two former employees, Dustin Clyde and Tyler Jackson. Under the act, private parties can sue for false claims on behalf of the government and share in any recovery. The act also permits the government to intervene in the lawsuit, as it’s doing here.