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Fraud Specific Skills

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Medicare fraud is big business for criminals. Though the exact figure is impossible to measure, estimates place Medicare losses due to fraud at approximately $60 billion annually. Because not all Medicare fraud is actually found. Successful fraudsters have some common skills that make them a good fit for fraud. Like having strong organization abilities, being good with numbers, and probably the ability to operate under pressure.  Some skills are more specialized, as in the case of Colby Joyner. Joyner only needed to know how to sign his name.

A physician assistant, Joyner had a contract with a physician staffing and telemedicine company. But Joyner didn’t meet patients.  Joyner electronically received from the telemedicine company prescription forms for “selected patients” to be approved for genetic testing. Specifically, cancer genomic and pharmacogenetic testing. It is not a test approved more than once by Medicare. This is a test that could result in life altering information if requested for patients who are sick. Therefore, it is not a test one wants to be deemed ineligible for because it had been used fraudulently in a Medicare scheme. Which is the position Joyner put the victims in when he certified over $10 million fraudulent claims.

Joyner got paid $12 for each signed claim. In total, Joyner received $3.6 million over two years, compromising the medical security of over 300,000 victims. Joyner should have considered a job using other skills of his.  On June 14, 2023, Joyner was found guilty of stealing for Medicare. The next thing Joyner will be signing his prison papers when he hands over his civilian clothes for prison garb.

Great job by the Health and Human Services in this investigation.

Today’s Fraud Of The Day is based on article “Physician assistant found guilty in $10M Medicare fraud scheme” published by Beckers Hospital Review on June 14, 2023

A physician assistant from Monroe, N.C., was found guilty for his role in a genetic testing scheme involving $10 million in fraudulent Medicare claims. A federal jury found Colby Joyner, 35, guilty of one count of healthcare fraud and six counts of making false statements relating to healthcare matters, according to a June 13 Justice Department news release. 

Mr. Joyner submitted the false claims in 2018 and 2019 while working as an independent contractor for a physician staffing and telemedicine company, according to the release. He signed fraudulent prescriptions for medically unnecessary cancer genomic and pharmacogenetic testing for hundreds of North Carolina Medicare beneficiaries. The telemedicine company gave Mr. Joyner pre-populated prescription forms and related records for patients who were pre-selected for genetic testing, and Mr. Joyner electronically signed and returned those in exchange for $12 — and later $15 — for each consultation he performed. 

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