Fraud On-the-Move

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Fraud sometimes occurs in a localized area, perhaps at one business location where perpetrators aim to keep their crime concealed. Other criminals commit fraud while on-the-move at different locations, which makes their illegal acts more difficult to detect. Fortunately, the Medicare Strike Force is really good at detecting and prosecuting both types of crime. Today, we take a look at an in-home Metro Detroit physician who was nabbed for participating in a $1.7 million healthcare fraud scheme.

 The West Bloomfield doctor worked for a mobile physician company in Lake, Michigan that purportedly provided in-home visits to homebound Medicare patients. According to today’s fraud article, for more than a year the doctor and his co-conspirators made in-home visits to Medicare patients who did not qualify under the government healthcare program for payment because they were either not ill or were not homebound.

In addition to billing for services that were not needed, the fraudster and his co-conspirators submitted miscoded bills, charging the highest amounts possible even though the visits were short and unnecessary. (The deceptive docs were counting on their patients and the government not examining the bills too closely.) And, he also referred patients for more home healthcare services that were not needed. (Once he had the tab open, he wanted to keep those charges coming.) So, what did the doctor get in exchange for his exorbitant billing practices? (His employer paid him more money for the constant stream of patients and extra income.)

After a two-week jury trial, the 41-year-old doctor from West Bloomfield was convicted on one count of conspiracy to commit healthcare fraud and sentenced to two years in prison for his role in the $1.7 million scheme. One co-defendant was previously sentenced to 18 months behind bars for healthcare fraud, while another is awaiting sentencing. The Chief Executive Officer of the mobile physician company the three co-conspirators worked for pleaded guilty in a related case in the Northern District of Illinois. He received a 15-month prison sentence. The fraud article also mentions that another doctor who worked out of the Chicago branch of the mobile physician company was sentenced to 40 months in prison for healthcare fraud.

I find it interesting that the physicians mentioned most likely took an oath to uphold ethical standards. Perhaps they took care of their patients, but somehow rationalized that it was ok to steal money from taxpayers, so they could have a nicer life. Fortunately, the Medicare Strike Force added another five fraudsters to their list of more than 3,500 defendants charged to date. (These successful convictions send a very clear message to fraudsters – whether stationary or on-the-move, criminals will be caught and punished.)

Today’s “Fraud of the Day” is based on an article entitled, Metro Detroit doctor sentenced to prison for $1.7 million health care fraud scheme,” posted on on January 18, 2018.

WEST BLOOMFIELD, Mich. – A Metro Detroit doctor was sentenced Thursday for his role in a $1.7 million health care fraud scheme.

Gerald Daneshvar, 41, of West Bloomfield, will spend 24 months in prison. Daneshvar was convicted in May 2017 after a two-week jury trial of one count of conspiracy to commit health care fraud.

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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.