Brace Yourself

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Medicare enrollment form and glasses

Every year, numbers show that the lion’s share of False Claims Act settlements and judgements involve healthcare fraud. One big factor to the high quantity of healthcare fraud settlements would be because of the skilled and aggressive efforts of the DOJ fraud enforcement agencies that are brought together to bring fraudsters to task. Many times, the investigations are so large in scope, they get named, such as the nationwide investigation called “Operation Brace Yourself.”

Operation Brace Yourself targeted schemes involving the payment of illegal kickbacks and bribes by DME companies in exchange for the referral of Medicare patients by medical professionals working with fraudulent telemedicine companies on medically unnecessary back, shoulder, wrist and knee braces. The scheme was estimated to over a billion dollars. That amounts to a lot of prescribed orders!

Nurse practitioner, Sherley Beaufils of Conyers, GA knew how to sign her signature to a medical order and got her pen in hand. Beaufort used identities that were generated by Co-conspirators through a telemarketing scheme to create medical orders. The telemarketers targeted the elderly and bundled the personal identifying information into “leads.” These leads were for sale with their target buyer being the fraudster.

Using those leads to fill out fake medical records, Beaufils would then sign her name in which she falsely claimed she provided examinations of those patients, and then created orders for orthotic braces for patients she never met or spoke with. One needs to only look at the orders that Beaufils wrote to know she didn’t meet the patients. Some prescriptions included a knee brace for an amputee, and a back brace for a recently deceased patient.

Beaufils profited by selling the fraudulent prescription orders for orthotic braces she signed. Her orders generated more than $3 million in fraudulent or excessive charges to Medicare and other insurance agencies.

Beaufils will have plenty of time to practice her signature. On August 8, 2022, Beaufils received an 87-month prison sentence and was ordered $1,635,161.61 in restitution.

Great job by the Department of Health and Human Services Office of Inspector General and for all the other agencies participating in Operation Brace Yourself.

Today’s Fraud of the Day comes from an article, “Nurse faked medical records in Medicare fraud scheme, feds say. She’s going to prison” published by The Telegraph on August 13, 2022

A Georgia nurse is facing just over seven years in prison and $1.6 million in restitution after prosecutors said she falsified medical records in a Medicare fraud scheme that targeted older adults.

With the help of co-conspirators, court documents show, Sherley Beaufils, 44, of Conyers, used the identities of people older than 55 obtained through telemarketing to order more than 3,000 medical braces. She never met or examined any of the patients, federal officials say.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.