Unlicensed Medical Assistant Convicted in $6 Million Fraud Conspiracy
A federal jury convicted an Illinois woman yesterday for conspiring to defraud Medicare of over $6 million.
According to court documents and evidence presented at trial, Rhonda Sutton, 58, of Matteson, worked as an unlicensed medical assistant for a physician in Chicago and surrounding areas from at least 2009 until at least 2012. In this position, Sutton conspired with others, including the owners of two home health care companies, to fraudulently certify Medicare beneficiaries for home health services for which those beneficiaries did not qualify.
Specifically, Sutton forged her physician employer’s signature on certification forms and supporting documentation, which caused Medicare beneficiaries to be enrolled in over 2,000 episodes of home health care at A&Z and Dominion home health agencies, both located in Lansing, Illinois. Sutton provided the forged physician forms to A&Z and Dominion, which enabled A&Z and Dominion to submit claims to Medicare for services that the beneficiaries did not need and were not qualified to receive. The owners of A&Z and Dominion paid Sutton kickbacks in exchange for the forged physician forms. A&Z and Dominion received over $6 million from Medicare due to Sutton’s fraudulent conduct.
Sutton was convicted of conspiracy to commit health care fraud. She is scheduled to be sentenced on March 16, 2023 and faces a maximum penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney John R. Lausch Jr. for the Northern District of Illinois; Assistant Director Luis Quesada of the FBI’s Criminal Division; Acting Special Agent in Charge John S. Morales of the FBI Chicago Field Office; and Special Agent in Charge Mario M. Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG), Chicago Regional Office made the announcement.
The FBI and HHS-OIG investigated the case, which was brought as part of the Chicago Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Northern District of Illinois.
Trial Attorneys Victor B. Yanz, Claire T. Sobczak, and Sarah W. Rocha of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Patrick Mott for the Northern District of Illinois prosecuted the case.
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 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 health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.