Kalispell woman pleads guilty in Medicare fraud

Two nurse practitioners in Montana this week admitted charges that they conspired to defraud Medicare of millions of dollars in a scheme in which they received money to sign fraudulent orders for orthotic braces.

According to acting U.S. Attorney Leif Johnson, Janae Nichole Harper, 34, of Kalispell, pleaded guilty April 21 to conspiracy to commit health-care fraud. Harper was a licensed nurse practitioner in Montana, Missouri, Nevada, South Carolina and Wyoming and was enrolled as a medical provider with Medicare.

Mark Allen Hill, 54, of Edinburg, North Dakota, and whose address of record for participation in the Medicare program was in Cut Bank, pleaded guilty on April 20 to conspiracy to commit health-care fraud. Hill was a licensed nurse practitioner in Montana, Iowa, Maine, Minnesota, North Dakota, South Dakota and Washington.

Hill and Harper each face a maximum 10 years in prison and a $250,000 fine.

Chief U.S. District Judge Brian M. Morris presided.

Chief Judge Morris set sentencing for both Harper and Hill for July 27 and continued their release.

Harper and Hill were among those indicted in a historic national health-care fraud and opioid enforcement action announced by the U.S. Department of Justice on Sept. 30, 2020. The enforcement action involved 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.

These defendants were charged with collectively submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine. Telemedicine uses telecommunications to provide various health-care services remotely.

IN COURT documents filed in Harper’s case, the government alleged that from Nov. 18, 2017 through July 16, 2019, Harper worked with certain staffing and telemedicine companies to commit health-care fraud and received money to sign brace orders that were prepared by telemarketers who had no medical training or certification.

Harper routinely signed these orders for Medicare beneficiaries regardless of medical necessity. She signed approximately 7,673 brace orders, which resulted in $8,259,849 billed to Medicare, of which Medicare paid approximately $4,307,934.

Harper was paid at least $94,395 for the orders she signed.

In court documents filed in Hill’s case, the government alleged that from Oct. 15, 2017 to April 24, 2019, Hill worked with certain staffing and telemedicine companies to commit health-care fraud and received money to sign unnecessary brace orders for Medicare beneficiaries regardless of medical necessity, often without ever talking to the Medicare beneficiary to determine whether the braces were medically necessary. Hill signed approximately 7,097 brace orders, which resulted in $10,055,436 billed to Medicare, of which Medicare paid approximately $5,054,866.

Hill was paid at least $124,900 for the orders he signed.

The case is being prosecuted by Assistant U.S. Attorney Michael A. Kakuk and Darren Halverson, Trial Attorney, and Robyn Pullio, former Trial Attorney, Fraud Section, Criminal Division of the Justice Department.

The enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, HHS-OIG, FBI, and DEA, as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic.