Examining the Examiners

330
43401192 - healthcare - red office folder on background of working table with stationery, laptop and reports. business concept on blurred background. toned image.

Medical examinations are required for many reasons. Children need a medical evaluation before they can attend school; an immigrant needs one if they wish to obtain a visa or green card and, some employers won’t hire until you’ve been looked over by a qualified physician. Today, we look at two medical examiners in Missouri who committed healthcare fraud by falsely claiming they were qualified to perform medical exams for truck drivers and veterans. (After examining the examiners, investigators determined that they were really fraudsters in disguise.)

The owner and president of a medical clinic that performed drug- and DNA-testing in Independence, Missouri did not have a medical license or medical credentials. Despite that fact, he signed the name of a licensed chiropractor without their consent on medical examination reports and certificates for approximately 65 commercial truck drivers. (The physical examinations are required by the Department of Transportation before drivers can get behind the wheel of a commercial motor vehicle.)

The other man involved in this case performed 53 examinations for veterans seeking disability ratings over a five-month period. During that time, he caused the submission of 209 Disability Benefits Questionnaires to the Department of Veterans Affairs (VA) incorrectly stating that another doctor had performed the exams. (The medical clinic owner knew he was not authorized to perform the examinations in the first place.)

Because of the duo’s illegal actions, the VA paid out $39,155 for the disability exams. Since the physicals were not performed by a credentialed provider, the VA had to re-adjudicate the claims. (This is a pain for veterans who are waiting to receive disability compensation from the government for injuries incurred while protecting their country.)

The 81-year-old owner from Missouri was subject to 15 years in federal prison without parole, however, he and his co-conspirator were both sentenced to five years of probation. (I’d say that they were pretty lucky.) They were also barred from conducting business with the federal government for five years. (How about never again?) The Federal Motor Carrier Safety Administration, which has a mission of preventing commercial motor vehicle-related fatalities and injuries, disqualified both men.

 This case brings to light a very important point the next time you have a doctor’s appointment scheduled. Be sure to check out their credentials and examine the examiner before you go to make sure you are receiving legitimate services from a qualified provider. (You never know, it could save someone’s life – even your own.)

Today’s “Fraud of the Day” is based on an article entitled, Missouri Men Sentenced to 5 Years Probation for Health Care Fraud,” published by Transport Topics on November 13, 2017.

Two Missouri men have been sentenced to five years probation and barred from doing business with the federal government for five years for their roles in administering over 100 fraudulent truck driver and veteran medical exams.

David Biersmith, owner and president of Industrial Medical Center in Independence, Mo., did not have a medical license or other medical credentials, but signed the name of a legitimate chiropractor without permission on medical examination reports and medical examiner’s certificates for at least 65 commercial truck drivers, according to the U.S. Department of Transportation Inspector General’s Office.

SHARE
Previous articleThe Heart of the Matter
Next articleBenefits of Blowing the Whistle

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.