General · May 28, 2021

Four Charged in Conspiracy that Billed More Than $20 Million

Four Charged in Conspiracy that Billed More Than $20 Million in False Claims to Medicare

(STL.News) Acting U.S. Attorney Bridget M. Brennan announced that a federal grand jury returned a twenty-four-count indictment charging four individuals for their roles in health care fraud conspiracy that billed more than $20 million in false claims to the Medicare program.

Named in the indictment are Thomas MOX, 53, of Grove City, Ohio; Ryan CASADY, 49, of Uniontown, Ohio; Elizabeth BALJAK, 35, of Pataskala, Ohio and Megan ILG, 53, of Grafton, Ohio.

MOX, CASADY, BALJAK and ILG are all charged with conspiracy to commit health care fraud.  In addition, defendants BALJAK and ILG are charged with false statements relating to health care matters.  Defendants MOX and CASADY are charged with additional counts of health care fraud and offer and payment of kickbacks in connection with a federal health care program.

Defendant MOX owned and operated a medical marketing company in Grove City, and a durable medical equipment company in Columbus.  Defendant CASADY owned and operated separate durable medical equipment companies located in Uniontown.  Defendants BALJAK and ILG were nurse practitioners, licensed and certified by the State of Ohio.

According to the indictment, from on or about March 2, 2018, to on or about September 9, 2019, the Defendants are accused of conspiring together to defraud Medicare by obtaining payment for unnecessary medical claims.

BALJAK and ILG, while working for telemedicine companies, are accused of signing prescriptions for medical braces regardless of medical necessity, without a physical examination and frequently without any contact with the beneficiary whatsoever.

It is alleged that these telemedicine companies would then transfer the prescriptions to medical marketing companies, including one owned by MOX, who would then use them as part of an unlawful package of Medicare beneficiary leads sold to durable medical equipment companies.  CASADY and others are accused of providing bribes and kickbacks to MOX in exchange for the leads packages, which they would then use to arrange for the ordering of the medical braces for beneficiaries.

In total, the Defendants are accused of billing more than $20 million worth of false claims to Medicare.

An indictment is only a charge and is not evidence of guilt.  A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.

If convicted, the Defendant’s sentence will be determined by the Court after review of factors unique to this case, including the Defendant’s prior criminal record, if any, the Defendant’s role in the offense, and the characteristics of the violation.

In all cases, the sentence will not exceed the statutory maximum, and in most cases, it will be less than the maximum.

This investigation was conducted by the Federal Bureau of Investigation, and the Department of Health and Human Services, Office of Inspector General.  This case is being prosecuted by Assistant U.S. Attorney Justin Seabury Gould.

SOURCE: USDOJ.Today