Nelson receives jail time, probation in health care fraud case

Ordered to pay more than $800,000 restitution


WEST BRANCH — Doris Annette Nelson was sentenced to six months in jail and 24 months probation in 34th Circuit Court Wednesday, June 6.

She was also ordered to pay $807,450.71 in restitution.

Nelson pleaded no contest in April to one count of health care fraud, filing false claims; one count of attempted health care fraud, filing false claims; and one count of Medicare fraud, false pretenses, after filing false insurance claims between December 2008 and October 2009 through her plastic surgery practice.

She had originally faced 18 separate charges, but those were reduced to three per her plea agreement.

Nelson’s attorney told the judge prior to Nelson’s sentencing that Nelson had suffered with alcohol addiction in the past, and the problem has returned since she was charged with health care fraud. He asked that the judge consider the penalties that Nelson had already received as a result of the case.

“As you consider her sentencing, we recognize that punishment is the goal of the justice system,” her attorney said. “But a lot of punishment has been handed out.”

He said Nelson has lost her practice, her profession, and her family life is “in shambles.”

Patricia Hammerle, a field investigator for Blue Cross Blue Shield, addressed the court prior to Nelson’s sentencing. She said health care fraud affects the costs that everyone pays for health insurance. She said the loss to Blue Cross Blue Shield as a result of Nelson’s actions totaled more than $1 million.

Gregory Weglowski, a special agent with the U.S. Department of Health and Human Services, also spoke, saying that Nelson was entrusted through her practice to give legitimate patient care. He said the loss to Medicare was $302,230.07.

Both Hammerle and Weglowski recommended that Nelson receive the maximum possible penalty.

Circuit Court Judge Michael Baumgartner presided over the case. He said Nelson must serve 35 days in the Ogemaw County Jail. At that time, she can be released to an in-house treatment program for alcohol abuse if it is available. The remaining 145 days will be held in abeyance, and Nelson will not need to return to jail if she successfully completes the program.

“Any time spent in the in-house treatment program is not jail time,” Baumgartner told Nelson. “That time will be held in abeyance, and if you have a relapse, that time will then be served.”

He said the way the sentence is structured, Nelson does have a chance to get her medical license back.

“But if you violate the delay of sentence, you probably will not be able to get your license back,” Baumgartner told her. “You would never practice medicine again in your life.”

Nelson will also receive one day credit for time already served.



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