Cross-country Fraud Deal Gone Bad

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Healthcare benefit forms including: enrollment forms and applications, stethoscope, calculator. Affordable healthcare remains an important topic around the world!

The illegal sale of controlled substances can be linked directly to the prescription drug epidemic the nation is currently facing. While prescription pain medicines are supposed to be carefully prescribed and regulated, mismanagement by healthcare professionals can easily go unnoticed, especially when they enlist someone outside of the healthcare profession to help them commit a crime. The girlfriend of a Pittsburgh, Pa. doctor pleaded guilty to conspiracy to illegally distribute oxycodone, commit health care fraud, commit money laundering, and theft of public money. (That’s quite a rap sheet. Some people will do anything for love.)

Marcia Arthurs admitted to conspiring to illegally distribute oxycodone, commit health care fraud, and laundering the money from the sale of oxycodone alongside her boyfriend and co-defendant, Paul Michael Hoover. (Marcia, Marcia, Marcia. What were you thinking?) Their healthcare fraud scheme lasted from March 26, 2015 to June 22, 2018. (Sadly, they successfully contributed to hundreds of people’s drug addictions for a little over three years.)

Hoover and Arthurs traveled from California to Pennsylvania for a few days at a time to manage their cross-country drug operation. Hoover would write the illegal oxycodone prescriptions in exchange for cash and Arthurs would manage the money they received. (Sounds like it was a match made in Fraud Heaven.) 

In addition to operating the pill mill, the couple received orders for oxycodone from Pittsburgh residents while residing in California. Arthurs and Hoover submitted preauthorization forms for oxycodone to Medicare and Medicaid as legitimate prescriptions. The dishonest couple used the oxycodone that the government healthcare programs paid for to sell to the buyers from Pennsylvania. (It’s definitely not a good idea to illegally sell illegally obtained drugs.)

The California couple also attempted to launder the proceeds from their ongoing drug operation. (There are many layers to this scheme that need to be unpacked. First they fraudulently obtain the controlled substance by defrauding healthcare programs. Then they sell it in a cross-country drug operation. Finally, they attempt to launder the funds from the scheme and get caught.)

To add to the list of crimes committed, Arthurs made false claims to the Social Security Administration about her living arrangements with Hoover and her total annual income. (You can’t exactly report drug dealer as your occupation on a government form.) This allowed her to fraudulently obtain $48,617.76 in Supplemental Security Income benefits.

Hoovers was previously sentenced to eleven years and four months in prison. He must also pay restitution to Medicare, Medicaid, and the Social Security Administration totaling $406,760.75.

Arthurs was sentenced to five years and three months in prison for participating in the healthcare fraud scheme. (I wonder if the relationship will hold up in prison.) She was ordered to pay restitution to the Social Security Administration totaling $48,617.00. Additionally, Arthurs must forfeit approximately $1.2 million in U.S. currency, gold, silver, and real estate. 

Report suspected healthcare fraud by contacting the Department of Health and Human Services’ Office of Inspector General hotline at (800) 447-8477 or through their online form.

Today’s Fraud of the Day comes from a Department of Justice press release, “Ex-Doctor’s Girlfriend Sentenced in Scheme to Illegally Distribute Oxycodone and Defraud Medicare and Medicaid,” on September 14, 2020.

PITTSBURGH – The girlfriend of a former Pennsylvania-licensed physician has been sentenced in federal court to a total of 63 months’ imprisonment on her conviction for conspiracy to illegally distribute oxycodone, conspiracy to commit health care fraud, conspiracy to commit money laundering, and theft of public money, United States Attorney Scott W. Brady announced today.

On September 14, 2019, Chief Judge Mark R. Hornak imposed the sentence on Marcia Ramsier Arthurs, age 62, formerly of Novato, California. Judge Hornak further ordered Arthurs to pay restitution to the Social Security Administration totaling $48,617.00, and to forfeit any interest she had in assets totaling approximately $1.2 million in U.S. currency, gold, silver, and real property.

 

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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.