Misconstrued

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12809472 - gesture of medical doctor's hand writing a note

The U.S. Food and Drug Administration (FDA) exists to ensure public health is protected. The agency ensures “the safety, efficacy and security of human and veterinary drugs, biological products and medical devices.” (They are also responsible for ensuring the safety of the nation’s food supply, cosmetics and radiation-emitting products.) A Gainesville, Florida doctor disregarded the rules and regulations set in place by the agency and bought non-approved drugs from outside of the country. She gave them to patients, then billed Medicare, Medicaid and Blue Cross Blue Shield of Florida as if they were approved medications. Her healthcare fraud scheme enabled her to steal more than $1 million from the two government programs and the private insurance company.

The doctor who masterminded the scam practiced medicine in two Florida locations including Gainesville and Hawthorne. She routinely submitted fraudulent billing claims for medically unnecessary tests and bought non-approved drugs from outside of the U.S. She then dispensed these foreign drugs to her patients without their knowledge or consent. (That’s a bit scary because no one wants to be a guinea pig without consenting to it first.)

As if that were not bad enough, she falsely billed Medicare, Medicaid and the private insurance company for the unapproved drugs in addition to counseling, treatment and training procedures that were never performed. (She purposely misdiagnosed and treated patients for her own personal gain.)

The physician’s office was eventually raided by Federal Bureau of Investigation (FBI) agents who were looking for evidence of fraudulent billing practices. When she did not hear anything back from the FBI, she spoke to the press claiming that the government had “misconstrued her practice as a place with a problem.” (Well, I’d say that is a fair assessment since she violated rules that were supposed to protect her patients.) Two years later she closed her medical offices citing she felt like she couldn’t run “the practice in the way that’s been best for patients in the past 20 years.” (Let’s not misconstrue the reality of the situation. She wasn’t running her practice in the best interest of her patients in the first place.)

After a five-week trial, the 59-year-old doctor was convicted on 162 out of 210 counts for false billing and using drugs not approved in the U.S. She was ordered to serve one year and one day in prison on each count; however, her terms will run concurrently. The fraudster must also pay a fine of $1.13 million plus more than $1 million in restitution. And last, but not least, she will serve three years of supervised release and perform 400 hours of community service. (What about revoking her medical license or preventing her from being a participating medical provider?)

The verdict in this case sends a pretty clear message to other medical providers who are thinking about betraying the government and other private insurance companies – don’t even think about defrauding the government, private insurance companies, or vulnerable policy holders. (Let’s hope that the defrauding doctor will not misconstrue her punishment.)

Today’s “Fraud of the Day” is based on an article entitled, Doctor sentenced to one year for health care fraudposted on Gainesville.com.

A Gainesville doctor convicted of 162 counts of health care fraud for false billing and using drugs not approved in the United States was sentenced Friday to effectively serve one year in prison and to pay a fine of more than $1.13 million plus restitution.

Ona Colasante, who had practices in Gainesville and Hawthorne, was convicted in May 2016 and sentenced Friday in federal court.

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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.