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SC Woman Charged with Healthcare Fraud and Identity Theft

shutterstock_95769358Woman Indicted on Charges of Identity Theft, Medicare Fraud, and Healthcare Fraud

On Friday, July 5th, a woman from Andrews, SC was indicted on charges of healthcare fraud, Medicare fraud, and identity theft, according to United States Attorney General Bill Nettles.

Queen Edwards Nesmith, 53 years old, was indicted by a federal grand jury on two counts of healthcare fraud, and one count of aggravated identity theft.

Nesmith was the owner of health care clinic Highmarket Primary Care, until she sold the business in 2007. However, even after she sold her Georgetown clinic, according to the indictment, Nesmith continued to bill Medicare for healthcare-related expenses – and she used the name and information for a doctor who no longer worked at the clinic.

The indictment states that Nesmith received more than $400,000 through her healthcare fraud scheme.

If convicted, Nesmith faces up to 10 years in prison, and a fine of up to $250,000 for the healthcare fraud charges. Aggravated identity theft could put her in prison for a mandatory 2 year sentence.

Healthcare Fraud Is Expensive for Government and Victims

According to the Federal Bureau of Investigation, healthcare fraud costs the United States an estimated $80 billion per year. As the costs of healthcare go up, and national healthcare spending surpasses $2.7 trillion, it is more important than ever to report Medicare, Medicaid, and healthcare fraud.

Here are some scams to watch out for that might make you, your insurance company, or Medicare/Medicaid, the victims of healthcare fraud:

  • Medical Equipment Fraud: Equipment manufacturers offer “free” products to individuals. Insurers are then charged for products that were not needed and/or may not have been delivered.
  • “Rolling Lab” Schemes: Unnecessary and sometimes fake tests are given to individuals at health clubs, retirement homes, or shopping malls and billed to insurance companies or Medicare.
  • Services Not Performed: Customers or providers bill insurers for services never rendered by changing bills or submitting fake ones.

Senior citizens can be particularly vulnerable to Medicare fraud, as many elderly people have long-term health problems, and rely on social services like Medicare to provide their care.

Per the FBI’s website, here are some tips to avoid Medicare, Medicaid, and healthcare fraud:

  • Never sign blank insurance claim forms.
  • Never give blanket authorization to a medical provider to bill for services rendered
  • Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
  • Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have questions.
  • Do not do business with door-to-door or telephone salespeople who tell you that services of medical equipment are free.
  • Give your insurance/Medicare identification only to those who have provided you with medical services.
  • Keep accurate records of all health care appointments.
  • Know if your physician ordered equipment for you.

The Strom Law Firm Protects Healthcare Fraud Whistleblowers in South Carolina

Common whistleblower actions include:

  • Medicare fraud,
  • defense contractor fraud, and
  • other kinds of fraud.

Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.

If you have first-hand knowledge of government or healthcare fraud occurring at your place of employment or your doctor’s office, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid, Medicare, and healthcare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800



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