Expensive medicine. Medical insurance. Drug addiction. Money and pills. Drugs.

Depending on the labor and ingredients required, costs for compounded medications can be quite expensive. A Georgia podiatrist committed healthcare fraud by participating in a kickback scheme that generated patients who supposedly needed compounded medications. He collaborated with a pharmacy, who billed the unnecessary expensive compounded medications to TRICARE, the government healthcare program that covers uniformed service members, retirees and their dependents.

Compounded drugs, which are medications made specifically for an individual’s medical condition, are based on a prescription provided by a doctor. (Pharmacists mix together the prescribed ingredients in a particular strength and dosage to produce this tailor-made medication.) The Columbus, Georgia podiatrist became involved in the healthcare fraud scheme involving compounded medications after being approached by the owners of a marketing company that paid kickbacks to medical professionals who provided patient referrals. The marketing company referred these patients, who had prescriptions for expensive compounded medications in hand, to a pharmacy that submitted the claims to TRICARE for payment. (This is the perfect example of the circle of the healthcare fraud lifecycle that goes ‘round and ‘round.)

In an attempt to cover up the kickback payments, the doctor signed false documentation that intimated he had received the additional funds for providing Medical Director services and for public speaking engagements. (But, because he texted and emailed his co-conspirators about the need to recruit TRICARE beneficiaries and prescribe the expensive compounded medication, I’m guessing the paper trail caused the healthcare fraud lifecycle to stop spinning.)

 In all, the Columbus-based podiatrist received $55,300 in kickbacks from the marketing company for referring a number of patients who supposedly required the specialized medications. The patient referrals resulted in the submission of claims for medications that cost around $4,700 per month. The doctor wrote enough prescriptions to cause TRICARE to pay $1,033,090 to the pharmacy. (All the co-conspirators profited greatly from this healthcare fraud scheme.)

 Following a week-long jury trial, the Columbus-based podiatrist was convicted of healthcare fraud. The 44-year-old was sentenced to three years in prison followed by three more years of supervised release. He must also pay a $300 special assessment and $55,300 in restitution.

While the government realizes that some people need specially concocted medications to treat a medical problem, it does not give medical professionals a license to defraud the country’s healthcare system. (Today’s fraudster, who took a Hippocratic Oath to take care of his patients, not only neglected that oath, but made a hypocrite out of himself by stealing from the federal government for personal gain.)

Today’s Fraud of the Day is based on a Department of Justice press release,Georgia Podiatrist Sentenced to 36 months for his role in Kickback Scheme, released on June 11, 2019.

A Georgia podiatrist was sentenced for his participation in a kickback scheme where he prescribed medication that was ultimately paid for by a federal program that provides low cost medication to members of the U.S. Armed Forces.
Ariana Fajardo Orshan, U.S. for the Southern District of Florida, Cyndee Bruce, Special Agent in Charge, Department of Defense Criminal Investigative Service (DCIS), Southeast Field Office, Christopher Cave, Special Agent in Charge, U.S. States Postal Service, Office of Inspector General, Southern Area Field Office (USPS-OIG), Frank Robey, Commander, U.S. Army Criminal Investigation Command, Southeast Fraud Field Office, H. Peter Kuehl, Acting Special Agent in Charge, FDA Office of Criminal Investigations (FDA-OCI), Miami Field Office, and Thomas W. South, Deputy Assistant Inspector General for Investigations, U.S. Office of Personnel Management, Office of Inspector General (OPM-OIG), made the announcement.

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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.