Former Department of Defense Civilian Employee Pleads Guilty In Health Care Fraud Case
Defendant Submitted False Claims to Federal Health Insurance Program
WASHINGTON – A Florida man pled guilty today to a federal charge of health care fraud for submitting more than 1,300 false claims, seeking about $152,000, to a federal health insurance plan, announced U.S. Attorney Channing D. Phillips and Norbert E. Vint, Deputy Inspector General for the Office of Personnel Management (OPM).
Jensen Moors, 41, currently of Lauderdale Lakes, Fla., pled guilty in the U.S. District Court for the District of Columbia. He is to be sentenced on Feb. 3, 2017, by the Honorable James E. Boasberg. Under the advisory federal sentencing guidelines, he faces a possible sentence of 12 to 18 months. Moors also agreed to pay restitution in an amount of $143,111, and a forfeiture money judgment in the same amount.
According to a statement of the offense, signed by the defendant, Moors was a civilian Department of Defense employee, who was entitled to participate in the Federal Employees Health Benefits Program, which is administered by OPM. U.S. government employees living overseas, such as Moors at the time of the offense, have the option to choose the Foreign Service Benefit Plan (FSBP) as their health care benefit program. Generally, those enrolled in FSBP pay out-of-pocket for any health care benefits, items, or services they receive overseas, and then submit claims for reimbursement for money already paid, to a location in the District of Columbia. An OPM contractor then processes the reimbursements and pays the employee directly.
Between about October 2007 and April 2014, Moors submitted to FSBP approximately 66 fake invoices with 1,387 claims totaling approximately €119,541 (euros, which translates to approximately $152,000), falsely claiming that he received and paid for physical therapy services from a German physical therapist. These claims were false in that Moors did not receive the therapy on the dates as claimed, the amounts were in excess of the prices charged by the physical therapist, and the duration of treatment was longer and more frequent than the treatment actually provided by the physical therapist.
As a result of these false claims, the OPM contractor paid Moors $143,111 on 63 invoices and denied the claims on the other three invoices, having discovered that the services were not provided.
In announcing the plea, U.S. Attorney Phillips and Deputy Inspector General Vint expressed appreciation for the work performed by Special Agents and analysts from both OPM’s Office of Inspector General and the Defense Criminal Investigative Service of the Department of Defense. They also acknowledged the efforts of those who are working on the case from the U.S. Attorney’s Office, including Paralegal Specialist Kaitlyn Krueger, Assistant U.S. Attorney Julia Jarrett, who is assisting with forfeiture issues, and Assistant U.S. Attorney Virginia Cheatham, who is prosecuting the case.