Thomas G. O’Lear, 58, of North Canton, Ohio, was sentenced to 15 years in prison and was ordered to pay $1,989,490 in restitution to Medicare, Medicaid, and two Medicaid Managed Care Organizations (MCOs). He was convicted at trial of defrauding Medicare and Medicaid of approximately $2 million by billing for x-ray-related services that his company did not provide, engaging in a cover-up scheme to conceal the fraud and committing aggravated identity theft. According to court documents and evidence presented at trial, O’Lear was President of Portable Radiology Services (PRS), a company that provided portable x-ray-related services to individuals residing in nursing homes, skilled nursing facilities and long-term care facilities.
From 2013 through 2017, O’Lear submitted false claims for reimbursement to Medicare, Medicaid and MCOs for thousands of x-rays and related services that he and his business did not provide, including approximately 151 x-ray services purportedly provided to patients on dates after the patients had died. Evidence also proved that O’Lear billed Medicare and Medicaid for purportedly having provided x-ray-related services to beneficiaries at nursing facilities on dates when the beneficiaries were hospitalized and not at the facilities. In another aspect of the fraud, O’Lear took multiple x-rays that had all been performed in one visit and falsely claimed that each one had been done on a different day, requiring separate reimbursement for transporting the portable x-ray equipment on each date. Similarly, O’Lear falsely billed for taking multiple images or views of patients when only one view had been done, thereby requiring a greater reimbursement.
During an audit by a Medicaid MCO, O’Lear covered up the scheme and committed aggravated identity theft by creating false medical records, including forms for ordering x-rays and radiology reading reports. He even falsified x-ray images, but was found to have re-used the same image repeatedly as different images of the same patient and even as images of different patients. In creating the falsified order forms, he forged the signatures of his employees and the physician he said had ordered the x-rays. As a result of the scheme, court documents state that O’Lear submitted fraudulent bills to Medicare, Medicaid and Medicaid MCOs for approximately $3.7 million and received approximately $2 million in payments as a result of fraudulent bills.
