Examining the Examiners

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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.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.