LOUISVILLE, Ky. (Oct. 24, 2013) – In a prescription fraud case, the owner of Crume Drug Store in Bardstown, Ky., was sentenced in federal court this month by Chief Judge Joseph McKinley to 27 months in prison, followed by a two-year term of supervised release, and was ordered to pay $242,963.04 in restitution, announced David J. Hale, U.S. Attorney for the Western District of Kentucky. There is no parole in the federal system.
Timothy Lee Sizemore, age 37, of Bardstown, was charged by information on Feb. 27, 2013, with one count of healthcare fraud and one count of wire fraud. According to information presented in court, Sizemore purchased Crume Drug Store in March 2010, then, between April 2010 and February 2012, Sizemore devised and executed a scheme to defraud Anthem and other private health insurance providers, and Medicare Part D.
Sizemore pleaded guilty as charged on March 20, 2013. Sizemore admitted that he created false names and placed them under his own Anthem policy number, created fraudulent prescriptions under those names, and billed Anthem for those fraudulent prescriptions, even though they were never actually filled. Also, Sizemore created fraudulent prescriptions using the names of Crume customers and local doctors, and billed the customers’ private insurance companies for those prescriptions even though they were never filled. During the same time period, Sizemore admitted that he used the names of Crume customers and local doctors to create fraudulent prescriptions and billed Medicare Part D for those fraudulent prescriptions, which were never filled. As part of his plea agreement, Sizemore paid full restitution of $242,963.04 prior to his sentencing hearing.
This case was prosecuted by Assistant United States Attorney David Weiser and was investigated by the Federal Bureau of Investigation (FBI) and U.S. Department of Health and Human Services, Office of the Inspector General.