Former Employee of Eye For Change Youth and Family Services Sentenced to Prison for Fraudulent Medicaid Billing Practices
CLEVELAND - Thomas G. O’Lear, 58, of North Canton, Ohio, was sentenced on Thursday, September 29, 2022, by U.S. District Judge Dan Polster to 15 years in prison and was ordered to pay $1,989,490 in restitution to Medicare, Medicaid and two Medicaid Managed Care Organizations (MCOs). Polster pronounced the sentence after O’Lear was convicted at trial of defrauding Medicare and Medicaid of approximately $2 million by billing for x-ray-related services that his company did not provide, engaging in a cover-up scheme to conceal the fraud and committing aggravated identity theft.
“This defendant wrongfully believed that he could cheat taxpayers by targeting nursing facilities and using the stolen identifies of vulnerable or deceased individuals to cover up his tracks,” said First Assistant U.S. Attorney Michelle M. Baeppler. “Protecting taxpayers and government healthcare programs from fraud is an important priority for the Department of Justice and law enforcement.”
“Medicare and Medicaid providers who submit fraudulent claims for reimbursement and engage in identity theft undermine the trust placed in them by the beneficiaries that utilize their services,” said Special Agent in Charge Mario M. Pinto of the U.S. Department of Health and Human Services - Office of Inspector General. “We will continue to work together with our law enforcement partners to ensure that individuals who commit fraud against federal health care programs are held accountable.”
“Criminal misconduct within the healthcare system is not only deceitful but also destructive,” said FBI Cleveland Special Agent in Charge Gregory Nelsen. “Mr. O’Lear’s schemes are appalling. Those who abuse their position of trust for financial greed will not be tolerated. The FBI and our partners will continue to work collaboratively to identify and investigate those committing fraud with the intention of bilking government programs.”
According to court documents and evidence presented at trial, O’Lear was President of Portable Radiology Services (PRS), a company that provided portable x-ray-related services to individuals residing in nursing homes, skilled nursing facilities and long-term care facilities.
From 2013 through 2017, O’Lear submitted false claims for reimbursement to Medicare, Medicaid and MCOs for thousands of x-rays and related services that he and his business did not provide, including approximately 151 x-ray services purportedly provided to patients on dates after the patients had died.
Evidence also proved that O’Lear billed Medicare and Medicaid for purportedly having provided x-ray-related services to beneficiaries at nursing facilities on dates when the beneficiaries were hospitalized and not at the facilities. In another aspect of the fraud, O’Lear took multiple x-rays that had all been performed in one visit and falsely claimed that each one had been done on a different day, requiring separate reimbursement for transporting the portable x-ray equipment on each date. Similarly, O’Lear falsely billed for taking multiple images or views of patients when only one view had been done, thereby requiring a greater reimbursement.
During an audit by a Medicaid MCO, O’Lear covered up the scheme and committed aggravated identity theft by creating false medical records, including forms for ordering x-rays and radiology reading reports. He even falsified x-ray images, but was found to have re-used the same image repeatedly as different images of the same patient and even as images of different patients. In creating the falsified order forms, he forged the signatures of his employees and the physician he said had ordered the x-rays.
As a result of the scheme, court documents state that O’Lear submitted fraudulent bills to Medicare, Medicaid and Medicaid MCOs for approximately $3.7 million and received approximately $2 million in payments as a result of fraudulent bills.
“Nobody needs X-rays after they’re dead, and the taxpayers shouldn’t have to pay for them,” Ohio Attorney General Dave Yost said. “This crook made victims of everybody who pays taxes, and he deserves every day of his sentence.”
This case was investigated by the United States Department of Health and Human Services, Office of the Inspector General (HHS-OIG), the Cleveland FBI and the Ohio Attorney General’s Healthcare Fraud Section . This case was prosecuted by Assistant U.S. Attorneys Elliot Morrison and Brendan O’Shea.