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Fraud Is Like A Game Of Poker

Fraud Is Like A Game Of Poker

Healthcare-Medicare-15
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

With the correct strategy, poker can become an easier game. The first step in developing that strategy is to categorize the opponent’s personality into distinct player types based on his playing style. Assigning a certain player type to the opponent helps to adjust the strategy against them. Billy Joe ‘Bildo’ Taylor, who supposedly lit up the Texas live streamed cash-game scene with his personality, was described as a “manic-playing poker whale.” In poker language that translates to a weak skilled, high stake (manic) player who has inexplicably large amounts of money (whale). Those excessive funds are usually due to unknown success in other areas of business. It may come as no surprise that Taylor was funding his poker game habit via Medicare fraud.

Taylor owned and operated several medical lab-test facilities across the United States. From November 2017 through May 2021, Taylors labs submitted roughly $130 million in Medicare claims. He received over $38 million in payments for tests, including urine drug testing and tests for respiratory illness during the COVID-19 pandemic that were deemed medically unnecessary, nor ordered by medical providers. Claims were submitted using confidential personal Medicare beneficiary information Taylor had fraudulently obtained.

Poker game invitations have since disappeared for Taylor since his assets were seized during the investigation and court proceedings. But there will be plenty of card games in jail for this manic playing poker player. Taylor was found guilty and sentenced on June 8, 2023, to fifteen years in prison and ordered to pay full restitution.

Great job by the FBI, the Health and Human Services Office of Inspector General, and the Internal Revenue Service Criminal Investigation in this investigation.

For more on all things fraud, don’t miss the new podcast, The FraudKast, launching on June 27, 2023.

Today’s Fraud Of The Day is based on article “Lavaca man gets 15-year sentence in COVID-19 fraud case, must pay back more than $29M” published by KARK News on June 8, 2023

A western Arkansas man was sentenced Thursday in federal court to 15 years in prison for conspiracy to commit health care fraud and money laundering in a pandemic scam.Billy Joe Taylor of Lavaca received the prison sentence and was ordered to pay $29,835,825 in restitution in a Fort Smith courtroom after pleading guilty to charges in October 2022.

Taylor was also assigned three years of supervised release after he completes his prison term.Court documents showed Taylor and the coconspirators submitted over $134 million in false and fraudulent claims to Medicare. The charges were for medical tests which were never given or were medically unnecessary, including respiratory illness tests during the COVID-19 pandemic.

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