Acting United States Attorney John A. Sarcone III announced on December 1, 2025, that a 50-year-old woman from Delray Beach, Florida, was sentenced in late October to 18 months in prison, followed by one year of home detention, for submitting false claims to healthcare benefit programs and issuing prescriptions for controlled substances outside the usual course of professional practice. The case was part of the Department of Justice’s 2025 National Healthcare Fraud Takedown.
The defendant, formerly an Albany resident, was a psychiatric nurse practitioner. Although she resided in Florida, she claimed to be practicing in Albany. She pleaded guilty to healthcare fraud for submitting false claims to New York State healthcare programs for services she never provided, including psychotherapy and evaluation and management services. These actions caused approximately $163,640 in losses.
She also pleaded guilty to unlawful drug distribution, sometimes called drug diversion, for prescribing amphetamine (e.g., Adderall) for non-medical purposes and outside the usual course of professional practice. From November 2018 to May 2023, she regularly issued prescriptions in the name of a former patient who had not been under her care since 2016. She filled 108 prescriptions at the request of a relative of the former patient.
As part of her sentence, the defendant was ordered to pay full restitution to the victims of her fraud, along with a $10,000 fine, and serve a two-year term of supervised release following imprisonment. In connection with her guilty plea, she also surrendered her DEA registration, which had allowed her to prescribe controlled substances.
In addition to her criminal penalties, the defendant resolved related civil claims. She admitted to submitting claims to Medicare for psychotherapy services that were never provided and using $48,670 in Provider Relief Funds (PRF) for impermissible purposes. These funds were allocated to healthcare providers under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) to cover costs related to the COVID-19 pandemic. She agreed to pay $188,850 to settle her False Claims Act liability.
“The defendant in this case, a nurse practitioner, put patients’ well-being in jeopardy and exploited healthcare programs meant to benefit her community,” stated Special Agent in Charge Naomi Gruchacz with the US Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG will continue to work with our law enforcement partners to protect essential programs and hold accountable those whose actions could result in potential patient harm.”
Compliance Perspective
Issue
Healthcare providers must ensure that claims submitted to federal and state healthcare programs accurately reflect the services rendered and are supported by proper documentation. Submitting claims for services that were not provided, improperly documented, or outside the usual scope of professional practice can result in significant civil and criminal penalties. Facilities are responsible for maintaining effective compliance programs, including procedures to prevent fraud, waste, and abuse, and for fostering a culture where staff feel safe reporting potential concerns.
Discussion Points
- Facilities should regularly review policies and procedures to ensure they prevent false or fraudulent claims, support accurate documentation, and comply with federal and state regulations. They should establish defined procedures for reviewing billing, prescription practices, and service documentation. Guidance from an experienced healthcare consultant can help identify gaps, provide best-practice recommendations, and strengthen overall compliance efforts. Policies should also clearly outline staff responsibilities for reporting suspected violations and maintaining professional standards.
- Staff should receive comprehensive onboarding and ongoing training on proper documentation, billing practices, and recognition of potential compliance issues. Training should include legal and ethical requirements for controlled substances, prescriptions, and healthcare claims. Med-Net Academy offers the course Red Flags of Fraud, which explains how to identify warning signs of potential fraud by outside contractors, the penalties for failing to detect fraud, proper procedures for reporting suspected violations, and guidance on handling external communications. Reinforcing a culture of compliance ensures that staff understand their role in preventing errors and reporting concerns without fear of retaliation.
- Periodically audit to verify that claims, prescriptions, and documentation adhere to facility policies and federal requirements. These audits should assess medical records, billing records, and controlled substance logs to identify gaps or inconsistencies and inform corrective actions. Engaging an external consultant can provide additional expertise, offering objective assessment, targeted recommendations, and mock survey support to strengthen internal controls and enhance risk mitigation.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*