Woman gets prison in health-care fraud

A mother's fear of going to prison and leaving behind her 12-year-old severely autistic son came true Friday despite strenuous pleas for leniency for her admitted involvement in a scheme that defrauded the U.S. military's insurance provider of more than $1.5 million.

In a two-hour hearing in his Little Rock courtroom, U.S. District Judge Brian Miller listened to arguments on behalf of Jennifer Sorenson, 39, of McKinney, Texas, who faced two to 2½ years in prison for participating in a health care fraud conspiracy carried out in 2015 in the Eastern District of Arkansas. While her efforts caused Tricare to lose $1.5 million, the amount she personally pocketed in kickbacks was $300,000.

Sorenson is one of seven people who have pleaded guilty in Little Rock to participating in the scheme. All but one -- Brad Duke of Little Rock, who prosecutors say was the ringleader -- have now been sentenced. Duke's sentencing hadn't been scheduled as of Friday.

Miller ultimately decided on a 14-month sentence for Sorenson after granting defense attorney Jordan Tinsley's request to sentence her below the 24-30 month penalty range recommended by federal sentencing guidelines, which calculated the range based largely on the amount of money involved.

Miller has so far imposed sentences in the case of between 8 months and 28 months, depending on each person's culpability and the amount of loss attributed to their actions, and said he is trying to be consistent.

He acknowledged that to the average person, a 14-month sentence seems way too short for causing the government to pay out $1.5 million unnecessarily, especially against a backdrop of increasingly unaffordable health care.

But he also acknowledged the federal Sentencing Commission's ongoing struggle to standardize punishment for white collar crimes while taking into consideration individual circumstances, and the "short but definite" sentences served by perpetrators of federal crimes, for which parole doesn't exist.

In contrast, many sentences imposed by state courts are longer initially, but defendants are then released months or years earlier on parole.

Sorenson, who throughout 2015 recruited Tricare-covered "patients" to receive expensive prescriptions they didn't need, in return for a share of Tricare's reimbursement, pleaded guilty Dec. 19 to conspiring to violate the anti-kickback statute.

On Friday, she broke down in tears while facing the judge from a courtroom lectern, saying, "The last three years have been an emotional imprisonment for me, and the fear of what could happen has been almost paralyzing."

About 30 supporters filled courtroom benches, and many had also written letters to Miller arguing for leniency for Sorenson.

While Assistant U.S. Attorney Alex Morgan requested a sentence within the suggested penalty range, Tinsley begged the judge to impose a sentence of five years probation -- with intermittent prison time, such as on nights or weekends, if necessary.

The judge noted that an unusually large amount of paperwork had been filed under seal in Sorenson's case, indicating that much of it concerned her private health matters and concerns about her three children, primarily her 12-year-old son.

Tinsley argued that while Sorenson's husband can undertake some of the responsibilities involving the boy, who is his stepson, there is no substitute for the care Sorenson herself can provide.

Tinsley also argued that Sorenson didn't realize, at least initially, that the doctor-authorized prescriptions were faked by an employee who was being paid to falsify them without the doctor's knowledge, or "she would have run."

"She blinded herself to a lot of red flags," Tinsley acknowledged. "She stuck her head in the sand and accepted" implausible explanations, "because she wanted this money."

At the time she was recruiting patients for Duke, she was making an annual salary of $170,000 working as a regional sales manager for a large, publicly traded medical device company, Morgan noted.

While the prosecutor argued that Sorenson's education and income warranted a longer sentence, if anything, Jordan insisted, "This is not a silver-spoon defendant." He said she was raised by a single mother and "pulled herself up by her bootstraps."

Miller replied, "I think society breaks down if we have judges who start letting people go home just because we feel sorry for them."

Morgan noted in a sentencing memo that Sorenson recruited 20 Tricare beneficiaries, urging beneficiaries to sign up other beneficiaries, sending messages like, "Come on ... let's do this!!!!!"

He described how, within 90 minutes of obtaining a Tricare beneficiary's name and insurance identification number, Sorenson "submitted a prescription for the most profitable three-drug combination possible, for which TRICARE would go on to pay $137,063, including $47,952 for the first month alone."

He quoted Sorenson's note to a subordinate who reported finding her first "pain cream person." Sorenson replied: "Yes!! Yeah!! Try to get her in the vitamins too! You make the most money on those."

When the subordinate replied, "She said she'd do vitamins too," Sorenson wrote back, "You're a rock star!!!!!!!!!!!!"

"With so much on the line every month, it followed that [she] and her subordinates did their best to stop TRICARE beneficiaries from cancelling prescriptions," Morgan wrote.

He cited Sorenson's note to a couple who had received $213,276 in drugs, which had earned Sorenson $42,655 at that point. Morgan said she urged the couple to order continuous refills, assuring them they would have to pay a copay only once, "So essentially your refills cost you nothing but do earn us income!"

Despite the pressure Sorenson put on the couple, they declined to continue receiving the unneeded medications, Morgan told the judge.

While Tinsley and Sorenson told the judge that a prison sentence for Sorenson would amount to punishment for an innocent 12-year-old child, Morgan said, "Let's not pretend there's no one else out there who has the capability to raise this young boy. If we didn't send people to prison that have kids, we wouldn't send people to prison."

NW News on 09/17/2019

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