Hindsight is 20-20


It’s usually easy to see the difference between doing something the wrong way vs. the right way after the fact. (That’s called hindsight.) An article posted on TulsaWorld.com tells about an optometrist who knew the difference between right and wrong, but made a very unwise decision to submit fake bills to Medicare and Medicaid for services that were not provided. (Let’s just say that the government and the optometrist didn’t exactly see eye to eye on the amount that was disbursed.)

The story states that for more than 10 years, the optometrist claimed he worked more hours that he actually did. Apparently, he billed Medicare for more than 12 hours a day on 387 occasions and more than 24 hours a day on 124 occasions. (Maybe he was just really bad at math.) One of the bills claimed he worked more than 68 hours in one day. (OK, maybe not.) He also billed Oklahoma’s state Medicaid program for more than 12 hours a day on 96 occasions.The bogus bills cost Medicare more than $1.3 million, while the state program lost more than $150,000 as a result of his criminal actions.

The government filed a lawsuit against the man, seeking more than $13 million or three times the damages including additional penalties. (The False Claims Act allows the federal government to recover triple the actual amount of damages for any false claims paid by Medicare and Medicaid.)

The 63-year-old optometrist denied any wrongdoing; however, he agreed to pay $150,000 to settle the federal lawsuit. There was no mention as to how the settlement would be divided between the federal and state programs.

Everyone knows that choices have consequences, some good and some bad. Mistakes also can provide a learning opportunity for those who choose unwisely. In this particular case, it’s pretty clear that the doctor’s choice to submit fraudulent bills was a bad choice. (It also appears that he got off easy.) Let’s hope this fraudster has learned a lesson and can now see more clearly as to how his actions have impacted his victims.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Claremont Optometrist Robert Charles Duke to Pay $150,000 in Medicaid, Medicare Fraud Case,” written by Curtis Killman and posted on TulsaWorld.com on January 28, 2015.

A Claremore optometrist has agreed to pay $150,000 to settle a federal lawsuit that alleged false Medicaid and Medicare billing dating back 10 years, prosecutors said Thursday.

Robert Charles Duke, 63, agreed to the settlement amount after state and federal prosecutors sued him and his Catoosa business, claiming the two had received more than $1 million in payments after submitting false and inflated patient billings over the years.

Read More

Previous articleStuck in the Middle
Next articleReplacing Fraud

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.