Wednesday, January 18, 2012

The Rare “Not Guilty Plea” in a Health Care Fraud Case

B. Elise Miller, of Coshocton, Ohio, entered a not guilty plea as she stood before federal magistrate Kathleen Burke, according to a recent report by ZanesvilleTimesRecorder.com.  She was indicted on fourteen counts of health care fraud this month and she has decided that professing her innocence is the best defense strategy.


The indictment stems from a joint health care fraud investigation conducted by the Ohio Attorney General’s office, United States Department of Health and Human Services, the Ohio Department of Insurance, and the FBI. Miller’s indictment is the most recent one, but back in 2010, Miller, her husband, Dana Campbell, and two other employees were separately indicted on separate federal charges.
Miller’s 2010 indictment charged her with witness tampering, obstruction of an official proceeding, concealment of records. Miller was the head of Three Rivers Infusion and Pharmacy Specialists. Her husband, Campbell, served as vice president. The current indictment charges Miller with defrauding Medicare and Medicaid by submitting claims under an alternate company’s name to avoid review of other claims by Three Rivers. Three Rivers billed Medicaid and Medicare Mutual of Ohio (MMOH) under the name Holzer Infusion Services. When MMOH finally figured out that Holzer and Three Rivers were one and the same, MMOH had already reimbursed Holzer over $700,000.


Separate charges in the indictment allege that Miller and Three Rivers submitted false claims relating to the drug Synagis. The search warrant and the affidavit contend that a home health care company received orders for the drug, but the drug was actually shipped to the patient’s home. A nurse would be sent to the home to administer the drug, but records reveal that Medicaid was billed for at least twice the amount of the doses of the drug actually administered.


If Miller is convicted of these charges, she faces up to ten years in prison.  Miller is of course presumed innocent until proven guilty.  

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