Modus Operandi


Fraudsters consider lying to be an important part of their modus operandi. (It’s just part of the job description.) A Federal Bureau of Investigation (FBI) press release tells about a Louisiana doctor who scammed Medicare out of millions of dollars by lying about the home health care referrals he wrote for beneficiaries that were not confined to their homes.

Because Medicare will pay for eligible home health care services such as intermittent skilled nursing care, physical therapy and occupational services, it is a huge target for fraudulent home health care companies and deceptive Medicare providers who want to make an easy buck. The article states that the doctor in this particular case wrote hundreds of false home health care certifications that were used by two deceptive home health care companies to fraudulently bill Medicare. (His referrals were used to submit bills for more than $2.2 million in services that were not needed or medically necessary.)

The 62-year-old doctor pleaded guilty to three charges, including one count of conspiracy to commit health care fraud and two counts of health care fraud. He is scheduled to be sentenced.

It is important to note that this doctor is the ninth defendant to plead guilty in a case that involved submitting more than $56 million in claims to Medicare over a seven-year period. (Unfortunately, Medicare paid out just under $51 million on the bogus claims before the operation was shut down.)

Lying has been around for a very long time and it’s a fair assumption that criminals will continue to deceive in order to take what does not belong to them. However, in this case, congratulations goes out to the Medicare Strike Force for bringing down these perpetrators and putting an end to the lies that stole benefits from those who deserved them the most. Even though it is likely that fraudsters will continue to deceive, the message is loud and clear to those who are interested in jumping on the home health care fraud bandwagon – your lies always catch up with you in the end.

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Louisiana Doctor Pleads Guilty to Health Care Fraud Charges for Writing False Home Health Certifications in $56 Million Fraud Scheme,” issued by the Federal Bureau of Investigation on April 23, 2015.

WASHINGTON—A Louisiana doctor pleaded guilty to federal health care fraud charges today, admitting that he wrote false home health care certifications that were used in a multi-million-dollar Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth A. Polite of the Eastern District of Louisiana, Special Agent in Charge Michael Anderson of the FBI’s New Orleans Field Office, Special Agent in Charge Mike Fields of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Regional Office and Louisiana Attorney General James D. ”Buddy” Caldwell made the announcement.

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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.