Criminal Justice News

Saturday, May 26, 2012

Monongahela Man Pleads Guilty to Defrauding Health Insurers

PITTSBURGH—A resident of Washington County, Pennsylvania pleaded guilty in federal court to a charge of health care fraud, United States Attorney David J. Hickton announced today.

Randall F. Guzik, 47, of 227 Galbreath Road, Monongahela, Pennsylvania, pleaded guilty to one count before Senior United States District Judge Maurice B. Cohill.

In connection with the guilty plea, the court was advised that from January 2007 to May 17, 2011, in the Pittsburgh area, Guzik defrauded two health care benefit programs—Highmark Blue Cross and Blue Shield, a health insurer serving western Pennsylvania (Highmark), and Anthem Blue Cross and Blue Shield, a health insurer serving Ohio and Kentucky (Anthem)—out of approximately $550,077.22.

Guzik prepared billings to Anthem for Highmark insureds residing in Western Pennsylvania for health care services such as conventional joint x-rays that were false in that no conventional joint x-rays were provided, the dates of the services were fabricated, the services were not provided in the locations represented on the billings, and the health care providers listed on the billings did not perform the services.

Judge Cohill scheduled sentencing for September 18, 2012 at 2:30 p.m. The law provides for a total sentence of not more than 10 years in prison, a fine of $250,000, or both. Under the Federal Sentencing Guidelines, the actual sentence imposed is based upon the seriousness of the offense and the criminal history, if any, of the defendant.

Pending sentencing, the court continued Guzik’s bond.

Assistant United States Attorney Nelson P. Cohen is prosecuting this case on behalf of the government.

The Federal Bureau of Investigation conducted the investigation that led to the prosecution of Guzik.

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