Fraud Minion

22477505 - medical and health insurance claim form with stethoscope on clipboard

When you think about minions, usually a cute yellow blob that loves bananas and wears blue jean overalls comes to mind. Even though the popular animated figures assist a former professional criminal portrayed in a popular children’s movie, the fictional characters are generally seen as harmless buffoons who do funny things. The person at the center of today’s “Fraud of the Day” highlights a son who was a minion for his ophthalmologist father. There was nothing funny about how they defrauded Medicare, private insurance companies and the Internal Revenue Service of $2.5 million.

The son served as the medical practice manager at his father’s ophthalmology office. He was responsible for running the day-to-day operations that included submitting bills to public and private health insurance plans. Court documents show that over six years, the father subjected his patients to unnecessary diagnostics tests and regularly billed the insurance plans for the services. The father and son duo also submitted bills for higher priced tests when lower cost ones were administered. And if that were not enough, they also double-billed. (They were going for all they could get.)

Healthcare fraud was not the only thing they were up to. The father and son transferred most of the company revenue to a straw company and used that income to pay for nearly $3 million in personal expenses. (They did not report any of the money to the Internal Revenue Service (IRS). Apparently, the practice of concealing personal and business income went on for six years).

Want to know what they did with all that money? They began building a 35,000-square foot multi-million-dollar home that was supposed to include a helipad, along with other amenities. (It was dubbed the “Temple of Oculus Anubis.” Google that for an interesting look at the location.)

A former employee, who happened to be the practice ‘s primary ophthalmologist and only surgeon, objected to fraudulently billing health insurance programs for the unnecessary tests that were performed on the patients. He was promptly fired. (The reason for the separation was listed as a reduction in revenue. Obviously, because the doctor wouldn’t take part in the fraudulent scheme.)

The father died of a stroke at age 80, before federal prosecutors could charge him. And a dutiful son was left “holding the bag” so to speak. During the trial a different picture was painted by the defendant ‘s attorney who said that the father was a controlling alcoholic who routinely abused his wife and son. The son ‘s lawyer explained to the court that he suffers from autism spectrum disorder and was acting as a servant for his “manipulative”, “monstrous” and “distorted” father.

This description was the opposite of the father ‘s obituary, which described him as a “devoted, caring and compassionate eye doctor.” (There are always two sides to a story.)

The judge sentenced the 41-year-old son to one year and one day in federal prison to be followed by three years of supervised release. He was ordered to pay $1.7 million in restitution to Medicare, a home-based health care company, and several private health insurance companies. He was also ordered to pay restitution of $817,378 to the IRS.

When sentencing, the judge did appear to have a heart and acknowledged the circumstances under which the son carried out his father’s wishes, however; he also felt that he did know right from wrong. While the judge determined that the son was not driven by greed to commit the fraudulent acts, he was still culpable for his actions. Let ‘s hope this man can serve the required time and move on to a better life.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Eye clinic manager convicted in huge health care fraud: Puppet of father or partner in crime?,” published by The Oregonian on April 4, 2017.

A 41-year-old man who cheated public and private health insurance plans and the Internal Revenue Service out of $2.5 million over seven years at his father’s eye clinic should spend at least 2 1/2 years in federal prison, a prosecutor argued Tuesday.

But a defense lawyer countered that Anthony Curtis Neal suffers from autism spectrum disorder and was acting as a “servant” for his “manipulative,” “monstrous” and “distorted” father.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.