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, 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.