Alpena nurse accused of submitting $3 million in false Medicare claims
ALPENA — An Alpena woman faces accusations she conspired with an out-of-state company to defraud Medicare of more than $3 million.
An indictment filed earlier this month in the U.S. District Court for the Eastern District of Michigan names Fawn Munro, a registered nurse, as a participant in a scheme to convince Medicare, a health care benefit program, to pay for items for which it does not provide coverage.
The charge alleges that in 2018 and 2019, Munro “devised and engaged in” a plan to ask Medicare for illegitimate reimbursements and altered patient files to support false claims to Medicare.
Munro’s attorney declined to comment for this story.
At the time of the alleged conspiracy, Munro worked as an independent contractor for telemedicine staffing companies, including a company out of Georgia, according to the indictment.
Court documents accuse Munro and “accomplices” of submitting fraudulent claims to Medicare and “diverting proceeds of the fraud for their personal use and benefit.”
The indictment names no other individuals in the suspect scheme and only refers to the Georgia business as “Company 1.”
According to the indictment, those involved in the alleged scheme submitted more than $3.3 million in ineligible claims, of which Medicare paid more than $1.8 million.
Claims to Medicare qualify for reimbursement only if the treatment was medically necessary and prescribed by a licensed physician.
The indictment accused Munro and others at Company 1 of ordering unnecessary ankle, knee, back, wrist, and other braces for Medicare beneficiaries who didn’t medically need them, sometimes without talking to the beneficiary.
It alleges that the “accomplices” at the company and Munro created, changed, and otherwise faked patient files and other records to convince Medicare to pay for the unnecessary braces.
Munro allegedly told Medicare that she believed patients needed the braces for their medical care and had performed diagnostic tests before ordering them, assertions the indictment called false.
Some of the beneficiaries named in the allegedly false orders lived in the federal court’s Eastern District of Michigan, which includes Northeast Michigan.
Munro’s LinkedIn page lists her as an employee in the cardiology department of MyMichigan Medical Center Alpena from 2015 to 2020. A MyMichigan Health spokeswoman did not reply to a request for comment.
The indictment makes no mention of Munro’s affiliation with the Alpena hospital and does not imply that the health system was involved in the alleged scheme.
Julie Riddle can be reached at 989-358-5693 or firstname.lastname@example.org. Follow her on Twitter @jriddleX.