FORMER HEALTH CARE CLINIC CEO PLEADS GUILTY TO HEALTH CARE FRAUD

 

LUBBOCK, Texas — The former Chief Executive Officer (CEO) of Oasis Medical Clinic in Plainview, Texas, Angela Michelle Edwards, pled guilty on Thursday in federal court to an information charging one count of health care fraud, announced U.S. Attorney Richard B. Roper of the Northern District of Texas. Edwards, 37, entered her plea before U.S. District Judge Sam R. Cummings, who ordered a pre-sentence investigation with sentencing to be scheduled after that investigation is completed. Edwards faces a maximum statutory sentence of 10 years in prison, a $250,000 fine and restitution.

Edwards admitted that from January 2002 through August 2005, she caused “up-coded” and improperly coded claims and diagnosis codes to be submitted to Medicaid, Medicare and private insurance companies in order to receive higher payments than those authorized by the payors. Even though she knew that only clinicians were authorized to make diagnoses and determine the level of a patient visit for payment purposes, Edwards personally changed bills submitted by the clinicians and taught her billing staff to routinely change bills by submitting claims for visits that were marked at higher levels than the ones indicated by the clinician and by adding patient diagnoses and procedures to the claims before they were submitted to the payors.

Edwards admitted that she is personally responsible for the restitution in this case because: she caused Oasis to be overpaid; she caused poor banking and accounting records to be kept; she unlawfully took money f rom Oasis’ accounts for personal expenses during her tenure as CEO; and Oasis is now in bankruptcy.

As a result of her actions, health care payors, including Medicare, Medicaid, Children’s Health Insurance Program and commercial insurance companies, paid Oasis $370,657 for fraudulent billings.

U.S. Attorney Roper praised the excellent investigative work of Texas Attorney General Greg Abbott’s Office - Medicaid Fraud Unit and the Federal Bureau of Investigation (FBI). The case is being prosecuted by Special Assistant U.S. Attorney Amy R. Burch of the Texas Attorney General’s Office.