Gainesville女子860万美元Medicare诈骗案被定罪：以伪造处方向联邦医疗保险报销矫形支具
美国司法部10月27日宣布，佛罗里达州中区联邦陪审团裁定57岁的 Gainesville 居民 Sophie Dufort 在一宗涉案逾860万美元的联邦医疗保险（Medicare）诈骗案中罪名成立。Dufort 拥有一家耐用医疗设备（DME）公司，并管理另外数家同类公司，诈骗对象主要是老年与残障受益人。
据法庭文件与庭审证据，Dufort 与70岁的 Ocala 居民 Paula Pirone 等人共谋，以伪造的医生处方为矫形支具向 Medicare 提出报销。她们从所谓营销公司非法购买处方：这些公司以高压操纵性电话营销套取 Medicare 受益人信息，有共谋者承认部分「海外来电」录音系伪造；营销公司继而付钱让医师在不接触、不评估病人的情况下签署处方，或盗用医生凭据伪造处方，再卖给 Dufort 一方的设备公司。
Dufort 一方随后把支具寄给受益人并向 Medicare 索赔数百万美元，尽管受益人并不想要、也不需要这些支具，且没有任何医生检查确认其需要。一名医学专家在庭上作证，这类支具组合对老年 Medicare 人群可能「非常危险」。当受益人投诉要求退货时，她们让对方「直接扔掉或转送他人」，以免向 Medicare 退款。
陪审团裁定的罪名包括：共谋实施医疗诈骗与电信诈骗（最高20年）、两项医疗诈骗（每项最高10年）、一项共谋诈骗美国并提供、支付非法回扣（最高5年），以及一项提供、支付非法回扣（最高10年）。量刑听证定于2027年1月举行。本案由卫生与公众服务部监察长办公室（HHS-OIG）与联邦调查局（FBI）调查，司法部助理部长 Colin M. McDonald 与佛罗里达州中区联邦检察官 Gregory W. Kehoe 宣布了裁决。
Gainesville Woman Convicted in $8.6M Medicare Fraud Scheme: Fake Prescriptions Used to Bill Medicare for Orthotic Braces
The U.S. Department of Justice announced on October 27 that a federal jury in the Middle District of Florida convicted Sophie Dufort, 57, of Gainesville, Florida, for her role in a Medicare fraud scheme that caused the submission of over $8.6 million in fraudulent claims. Dufort owned a durable medical equipment (DME) company and managed several other DME companies; the scheme took advantage of elderly and disabled beneficiaries.
According to court documents and evidence presented at trial, Dufort conspired with Paula Pirone, 70, of Ocala, Florida, and others to submit fraudulent claims to Medicare based on fake doctors' prescriptions for orthotic braces. The conspirators illegally purchased the prescriptions from purported marketing companies that used high-pressure, manipulative telemarketing calls to obtain Medicare beneficiaries' information; one co-conspirator admitted some of the purported call recordings from overseas "would be faked." The marketing companies then paid medical practitioners to sign prescriptions without contacting or evaluating patients, or stole doctors' credentials to create forged prescriptions, and sold them to the conspirators' DME companies.
Dufort and her co-conspirators then shipped braces to beneficiaries and billed Medicare for millions of dollars, even though the beneficiaries did not want or need the braces and no doctor had examined them. A medical expert testified that using these combinations of braces could be "very dangerous" for the elderly Medicare population. When people complained and wanted to return the braces, they were told to "just get rid of them or just pass them down" so the conspirators would not have to pay Medicare back.
Dufort was convicted of conspiracy to commit health care fraud and wire fraud (maximum 20 years), two counts of health care fraud (10 years each), one count of conspiracy to defraud the United States and to offer and pay illegal kickbacks (5 years), and one count of offering and paying illegal kickbacks (10 years). Sentencing is scheduled for January 2027. The case was investigated by the Department of Health and Human Services Office of Inspector General (HHS-OIG) and the FBI, and was announced by Assistant Attorney General Colin M. McDonald and Middle District of Florida U.S. Attorney Gregory W. Kehoe.
来源：GSM·美国（原文链接）
图片来源：图：位于 Tampa 的 Sam M. Gibbons 联邦法院，佛罗里达州中区联邦法院所在地（资料图）。Ebyabe 摄，Wikimedia Commons，CC BY-SA 3.0。Photo: The Sam M. Gibbons United States Courthouse in Tampa, home of the U.S. District Court for the Middle District of Florida (file photo). By Ebyabe, Wikimedia Commons, CC BY-SA 3.0.
