Monongahela Man Sentenced to Prison for Defrauding Highmark
PITTSBURGH - A resident of Monongahela, Pa., has been sentenced in federal court to 37 months of incarceration and restitution of $550,077.22 on his conviction of health care fraud, United States Attorney David J. Hickton announced today.
Senior United States District Judge Maurice Cohill imposed the sentence on Randall Frederick Guzik, 47.
According to information presented to the court, from January 2007 to May 17, 2011, in the Pittsburgh area, Guzik defrauded Highmark Blue Cross and Blue Shield, a health insurer serving western Pennsylvania out of approximately $550,077.22. Guzik prepared billings for Highmark insureds residing in Western Pennsylvania for health care services, such as conventional joint x-rays, that were false in that no conventional joint x-rays were provided, the dates of the services were fabricated, the services were not provided in the locations represented on the billings, and the health care providers listed on the billings did not perform the services.
Prior to imposing sentence, Judge Cohill stated, "This was an extremely sophisticated and complicated scheme. The sentence called for under the sentencing guidelines is appropriate."
Assistant United States Attorney Nelson P. Cohen prosecuted this case on behalf of the government.
U.S. Attorney Hickton commended the Federal Bureau of Investigation for the investigation leading to the successful prosecution of last name of Guzik.