Nurse Practitioner Sentenced for $12 Million Fraud

News Summary

Alexander A. Istomin, a nurse practitioner in East Greenwich, has been sentenced to seven years in prison for defrauding health insurers and Medicare of nearly $12 million. His fraudulent activities included submitting claims for services that were never provided and spanned multiple states. The case highlights significant challenges in Rhode Island’s healthcare system, particularly the critical shortage of primary care providers and the increasing reliance on nurse practitioners. The outcome emphasizes the importance of accountability in healthcare to maintain patient safety.

Rhode Island – A nurse practitioner in East Greenwich has been sentenced to seven years in prison for defrauding health insurers and Medicare of nearly $12 million. Alexander A. Istomin, who operated a “ghost practice,” was found guilty of fraudulent billing practices and is ordered to pay restitution of the full amount he defrauded, along with a fine of $30,000. This case highlights the ongoing challenges in the healthcare system, including a shortage of available physicians and growing dependence on nurse practitioners.

While working at the South County Health Medical and Wellness Center, nurse practitioners like Erica Ogni manage a vast number of patients. This trend underscores the increasing role of non-physician practitioners in healthcare, especially as Rhode Island faces a critical shortage of primary care providers. The number of nurse practitioners in the state has surged by 34%, from 1,103 in 2019 to 1,475 in 2024. With an estimated 300,000 Rhode Islanders lacking access to primary care, these healthcare professionals are becoming indispensable.

However, the rise of nurse practitioners has also raised concerns. The American Medical Association has voiced apprehensions regarding their expanding roles, noting that even though nurse practitioners can diagnose illnesses and prescribe medications, they do not have the same level of training as doctors. These issues are accentuated by cases such as Istomin’s, which reveal vulnerabilities in the system and could potentially affect public trust in healthcare providers.

Iston’s fraudulent activities were not confined to Rhode Island. His fraudulent schemes spanned multiple states, including Florida and New York. Operating from his supposed office at 58 Main Street in East Greenwich, Istomin submitted claims for services that he never provided, amounting to $11,923,686.30 in false claims. Initially, investigators estimated his fraudulent activities at $2.3 million, but subsequent investigations uncovered the full extent of his deception.

According to court findings, Istomin utilized various tax identification numbers and patient information to create and manage fraudulent prescriptions for resale. His claims included billing for medical services while he was out of the country, including trips to Russia. These actions not only resulted in his conviction but also served to further deplete the already weakened healthcare system, exacerbating the access issues faced by many Rhode Islanders.

U.S. District Chief Judge John J. McConnell, Jr. presided over the case and emphasized the severity of Istomin’s actions, which obstruct legitimate medical care and inflict financial harm on patients and health insurers. The prosecution was led by Assistant U.S. Attorney Dulce Donovan, with the case supported by federal agencies, including the Department of Health and Human Services, FBI, and the FDA.

The outcome of this case serves as a critical reminder of the importance of accountability in healthcare. As nurse practitioners continue to play an essential role in addressing the needs of a growing patient population, maintaining rigorous standards is crucial to ensure patient safety and efficacy in care. The healthcare landscape in Rhode Island is currently at a crossroads, confronting both the challenges of a physician shortage and the implications of fraud, which demand immediate attention and action.

Deeper Dive: News & Info About This Topic

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