Kittery businessman pleads guilty to more than $200,000 in health care fraud

By Judy Harrison, BDN Staff
Posted Oct. 19, 2011, at 9:45 a.m.

PORTLAND, Maine — Seacoast Sleep Solutions, a medical equipment supplier, and its president Peter Enzinger, 44, of Kittery pleaded guilty Tuesday in U.S. District Court to committing health care fraud, according to court documents.

Between 2005 and August 2010, Enzinger developed and executed a scheme for his firm to defraud public and private insurance carriers of about $220,000 by billing them for products not delivered to patients and for more expensive products than those actually delivered. Enzinger and his firm also continued to bill the carriers for equipment already returned by patients, according to the prosecution version of events to which he pleaded guilty.

Court documents filed in federal court in Portland include examples of Enzinger’s fraudulent billing. In August 2009, a Seacoast employee delivered a standard hospital bed to a patient in Lebanon. Enzinger changed the records to reflect the delivery of a bariatric bed, which holds a larger person and is reimbursed at a higher rate than a standard bed. He also modified records for the patient to show the sale of a gel foam mattress and the rental of a trapeze bar, which never were delivered.

By pleading guilty, Enzinger also admitted that in 2007 he set up a program in which clients could sign up for automatic shipping of supplies for equipment. Bills were sent out to insurers automatically. Seacoast was paid but the supplies were not delivered, according to court documents.

As a result of these and other fraudulent practices, Seacoast overbilled Medicare by more than $145,600, Anthem by more than $49,000 and Martin’s Point by more than $25,000.

It could not be determined Wednesday from court documents what Enzinger spent the money he bilked from insurance companies on.

In July, Enzinger was convicted by a federal jury of making false statements on a loan application submitted to the U.S. Small Business Administration on behalf of Seacoast. Jurors found that Enzinger had lied about his criminal record on the loan application in 2009. He said his record included nothing more serious than speeding or traffic violations.

Court records from Worcester District Court in Worchester, Mass., from 1985, 1987 and 1990 were introduced during the trial, according to court documents. At that time, Enzinger’s last name was Shays.

Information about the nature of those crimes was not available Wednesday.

Enzinger faces a maximum sentence of 10 years in prison and a fine of up to $250,000 on health care fraud; Seacoast faces up to five years probation and a maximum fine of $500,000. Enzinger and the firm are expected to be ordered to pay restitution.

In his plea agreement with federal prosecutors, Enzinger waived his right to appeal his conviction to the 1st U.S. Circuit Court of Appeals in Boston if he is sentenced to not longer than nine months. He also agreed to forfeit the $50,000 deed of trust posted earlier this year as bail. The money is to go toward restitution, according to the plea agreement.

In addition to those penalties, Enzinger faces up to two years in prison and a fine of up to $5,000 for his conviction on the charge of lying to the Small Business administration.

The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation, according to a press release issued Tuesday by the U.S. Attorney’s Office.

http://bangordailynews.com/2011/10/19/news/portland/kittery-businessman-pleads-guilty-to-more-than-200000-in-health-care-fraud/ printed on July 22, 2014