Go Big or Go Home

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Calculator and stethoscope on paperwork

Most of the workers’ compensation fraud stories covered on FraudOfTheDay.com tend to involve small to medium-sized businesses who try to defraud state workers’ compensation programs or private insurers by underreporting payroll to avoid high insurance premiums. (Or they simply don’t provide workers’ compensation insurance to their employees, hoping that no one will be injured.) Today’s fraudster from San Antonio, Texas decided to go big and defraud the Federal Employees Compensation Act (FECA) program.

The FECA program provides compensation to federal civil service employees for any wages lost because of a job-related injury. The businessman in today’s fraud article, who owned and operated a physical therapy and rehabilitation company in San Antonio and Salt Lake City, Utah, carried out his workers’ compensation fraud scheme for more than four years. During that time, he billed the program for more than $8.4 million in services and received $6.3 million for his fraudulent claims.

When investigators delved into the details, they found that the owner was able to submit bills under a licensed physical therapist’s (PT) identity. (The PT obviously had no idea that their identity was being used to commit a crime.) The company owner used codes that indicated a qualified professional provided the services, when unlicensed technicians were the ones providing treatments. (Thankfully, it does not appear that anyone was injured.)

The 40-year-old businessman from San Antonio was convicted of healthcare fraud and aggravated identity theft for collecting more than $6.3 million in government benefits he did not deserve. Today’s fraudster faces up to 10 years in federal prison for the healthcare fraud convictions, up to 20 years for wire fraud and up to another two years for aggravated identity theft. (“Go big or go home” is a likely thought he may have had when plotting out his illegal healthcare fraud scheme. Except now, he may be headed to the Big House – a.k.a. prison – instead of his home when all is said and done.)

Today’s “Fraud of the Day” is based on an article, San Antonio business man convicted of health care fraud,” published by the Houston Chronicle on June 21, 2019.

A San Antonio businessman was convicted Friday of engaging in health care fraud, according to a press release from the office of the U.S. Attorney of the West District of Texas.

Rafael Enrique Rodriguez, 40, was convicted by a federal jury on six counts of health care fraud, five counts of wire fraud and one count of aggravated identity theft.

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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.