Feds Charge Elmhurst Woman with Healthcare Fraud

A 30-year-old Elmhurst woman has been charged with engaging in a scheme to defraud the Medicare program.
       
Ellyse Lamon is among seven defendants in the Chicago area charged in separate instances of healthcare fraud, federal law enforcement officials announced Tuesday. Lamon, an account executive at a company that sells durable medical equipment, was charged in U.S. District Court with one count of healthcare fraud for allegedly engaging in a $350,000 Medicare false billing scheme.
        
Lamon's company sold equipment such as back braces and transcutaneous electrical nerve stimulation units, also known as tens units. Between October 2010 and May 2011, Lamon allegedly caused her company to submit false claims to Medicare stating that a physician had prescribed back braces and tens units when she knew that no physician had done so and the items were not medically necessary. 

In order to provide written support for the false claims, Lamon allegedly obtained patient records without a physician’s permission and added false information reflecting that a physician had ordered the equipment for the patients. She allegedly forged doctors’ signatures on documents, including false treatment records she created. According to the charges, Lamon further used patient information she had inappropriately accessed at a pain medicine center in Chicago to set up patient meetings where she falsely told patients that doctors had prescribed the equipment for them.
      
Lamon allegedly submitted false claims to Medicare totaling $352,685, resulting in payment of at least $206,233 to her medical equipment company. She allegedly profited from these false claims by receiving increased commissions and other benefits from her company.
 
The case was investigated by the FBI. The charge carries maximum penalty of 10 years in prison and a $250,000 fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater.

“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Eric Holder.

The public is reminded that indictments, informations, and complaints contain only charges and are not evidence of guilt.  The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.