United States Attorney Kenyen R. Brown of the Southern District of Alabama and Special Agent in Charge Robert Lasky of the Mobile Division of the FBI announce that Certified Nurse Practitioner Diantha Miller has been sentenced to 12 months and one day in federal prison, and has been ordered to pay $347,868.26 in restitution to Blue Cross/Blue Shield of Alabama. Her sentencing comes three months after a federal jury found Miller guilty on two counts of healthcare fraud and one count of conspiracy.
At trial, the evidence established that while Diantha Miller was the co-owned the Laser Skin Care Center of Mobile, she engaged in a scheme to fraudulently up-code, a scheme to fraudulently re-code, and conspired to with others to engage in both schemes. Specifically, the jury found that Miller knowingly and willfully engaged in a scheme to falsify bills to insurance companies so that it would appear as if services were performed by Dr. Carpenter, not Miller. This was done because patient services are reimbursed at higher rates when performed by physicians. In addition, Miller knowingly and willfully engaged in a scheme to fraudulently alter billing codes on rejected bills so that the Laser Skin Care Center would be reimbursed. Finally, the jury found that Miller conspired with Dr. Carpenter to commit these crimes. As co-owners of the business, Miller and Dr. Carpenter both benefited financially from the fraudulent billings. In total, these fraud schemes resulted in Laser Skin Care Center receiving nearly $1 million in fraudulent reimbursements.
At Diantha Miller’s sentencing hearing, U.S. District Court Judge Callie V.S. Granade found that a reasonable estimate of the restitution owed to Blue Cross/Blue Shield was $347,868.26, but that the true loss caused by Miller’s fraudulent schemes was between $400,000.00 and $1,000,000.00. Judge Granade also found that Miller organized and supervised the fraud schemes, and that her actions abused the trust instilled in her by Blue Cross/Blue Shield. Ultimately, Judge Granade concluded that incarceration for 12 months and 1 day was a sufficient period of time to meet the ends of justice in this case.
United States Attorney Kenyen Brown was pleased with today’s result: “By sentencing defendant Diantha Miller to over a year in federal prison, the Court has sent a strong message that those willing to engage in fraudulent medical billing practices should expect to wind up in federal prison. My office will continue to vigorously prosecute fraud cases, particularly fraud cases that syphon money away from our healthcare system." Special Agent in Charge Robert Laskey also noted: “Health Care Fraud continues to be a tremendous problem, draining taxpayers’ dollars and putting them in the pockets of criminals," said FBI Special Agent in Charge Robert F. Lasky. “The FBI will continue to dedicate a substantial amount of investigative resources to pursue those that steal from our healthcare system." A spokesperson for Blue Cross and Blue Shield of Alabama said the company is pleased with today’s ruling: “Financial losses due to healthcare fraud have a direct effect on our members. Blue Cross remains committed to fighting fraud and abuse to protect our members’ health and well-being and help reduce the cost of healthcare."
This case was investigated by FBI-Mobile and prosecuted by the U.S. Attorney’s Office for the Southern District of Alabama.
Source: U.S. Department of Justice, Office of the United States Attorneys
