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Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Workplace performance bonuses are a great thing, unless they are driven by incentives that can send you to jail. That is the case for a pair of Texas women who were convicted recently on six counts of healthcare fraud that involved overbilling the federal workers’ compensation program out of $5.5 million.

The two women – a 48-year-old from Lorena and a 42-year-old from Grand Prairie – worked in the billing office for Dr. Les Benson, an emergency medicine physician in Waco and former pro football player with the Dallas Cowboys in the 1970s. (Now there’s a convenient connection to people at risk of injuries.)

Benson was indicted on related fraud charges and his medical license was suspended in 2018. (Although he was not mentioned in court documents involving the billing clerks.)

Criminal complaints stated that “Physician A” incentivized the billing clerks to maximize billing by offering a bonus if their respective clinics billed more than $50,000 per week. (That’s an odd business model for a practitioner who supposedly cares about his patients.) The billing clerks submitted and/or taught others to submit false healthcare claims between January 2011 and March 2017.

A federal jury convicted the Lorena woman after a five-day trial. The Grand Prairie woman pleaded guilty to healthcare fraud and is scheduled to be sentenced in March for billing the Department of Labor’s Office of Workers Compensation for more physical therapy work than was performed.

Today’s Fraud of the Day comes from the news report, “Texas Woman Convicted in $5.5 Million Health Care Fraud Scheme, DOJ Says,” published Dec. 14, 2019.

A Texas woman was convicted Friday on six counts of health care fraud in connection with a $5.5 million federal workers’ compensation overbilling scheme, U.S. Justice Department officials said.

Melissa Sumerour, 48, of Lorena, was found guilty by a federal jury following a five-day trial, DOJ officials said in a statement.

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