Medical Equipment Supplier Imprisoned for Medicare Fraud Scheme

A federal judge has sentenced a Florida man to a 12-year prison term and three years of supervised release for attempting to defraud the U.S. government of $61.5 million in false Medicare claims for durable medical equipment (DME). Peter Roussonicolos, 64, also must pay $21,195,540.18 in restitution and forfeit $2,514,040.

“This sentence underscores HHS-OIG’s firm commitment to thoroughly investigating individuals who engage in illegal kickback schemes to prescribe medically unnecessary durable medical equipment for their own personal financial gain,” said Deputy Inspector General for Investigations Christian J. Schrank with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “We remain steadfast in our mission to protect the integrity of Medicare and other federal healthcare programs as well as the people served by those programs.”

According to court documents, Roussonicolos, of Port Saint Lucie, Fla., owned and operated five DME suppliers as a silent partner. Roussonicolos hid his involvement in the companies from Medicare because he had one or more felony convictions, rendering him ineligible to enroll with the government program. To further conceal his involvement, federal prosecutors say he recruited and paid co-conspirators to serve as nominee owners of the DME suppliers and caused others to falsify Medicare enrollment forms, bank records, and other documents to conceal the true ownership and control of the DME suppliers. He also knew that a co-conspirator paid kickbacks and bribes to patient recruiters in exchange for beneficiary referrals. As part of the scheme, the DME companies submitted approximately $61.5 million in false and fraudulent claims to Medicare for medically unnecessary DME that was ineligible for reimbursement and were paid approximately $26.7 million of these claims.

“Through lies and deceit, the defendant and his co-conspirators orchestrated a $61 million fraud on Medicare,” said Matthew R. Galeotti, head of the Justice Department’s Criminal Division. “The defendant’s fraud drained critical government resources that could have been used to help vulnerable Americans. The sentencing demonstrates the Department’s steadfast commitment to protecting taxpayer dollars and ensuring accountability for those who seek to defraud our healthcare programs.”

Roussonicolos pleaded guilty last fall to conspiracy to commit healthcare fraud and wire fraud. The FBI and HHS-OIG investigated the case.

“This defendant and his co-conspirators orchestrated an elaborate scheme to steal millions from Medicare through kickbacks and sham billing,” said Assistant Director Jose A. Perez of the FBI Criminal Investigative Division. “The sentencing demonstrates that those who exploit our healthcare system for personal gain will be held accountable. The FBI is committed to working with our partners to protect taxpayer dollars and ensure the integrity of healthcare programs.”

Trial attorney Jennifer Burns and Assistant Chiefs Jamie de Boer and Emily Gurskis of the Criminal Division’s Fraud Section prosecuted the case. Trial attorneys Joanna Bowman and Lindita Ciko Torza of the Special Matters Unit assisted in the prosecution.

The Fraud Section leads the Criminal Division’s efforts to combat healthcare fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal healthcare programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in healthcare fraud schemes.