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December 13, 2018

Healthcare Providers Should Note Recent Fraud Conviction

By Bart Daniel, Elle E. Klein


Originally published in Law360

On Nov. 20, 2018, former speech therapist Gena Randolph was sentenced to 111 months in federal prison and ordered to pay $580,937.44 on convictions of criminal health care fraud. This sentence is noteworthy in that it fell above the applicable sentencing guidelines range and practitioners need to be aware of its implications.

Randolph had been excluded from Medicaid and Medicare after her 2012 conviction for filing false claims with the South Carolina Medicaid program. Federal regulations provide that exclusion from future participation in federal health care programs is mandatory upon the conviction of a program-related crime or a felony conviction relating to health care fraud.[1] For purposes of this exclusion, “federal health care program” includes programs funded in whole or in part by the United States.[2] Additionally, federal law specifies exclusions from the state-administered Medicaid programs in many instances.[3] Thus, Randolph was prohibited from participating in any federal health care program after her 2012 conviction.