No Show’ Means ‘No Go’

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A lot of health care fraud is committed by medical providers who claim they performed procedures on patients, when in reality they did not. (It’s one of the oldest tricks in the fraud book.) They fraudulently bill government insurance programs for the bogus care, and it’s not long before the reimbursement check is in the mail. (Sounds like easy money to me.) A Department of Justice press release details how one doctor stole approximately $13 million from Medicare and Medicaid through his Brooklyn health clinic.

The story states that while the doctor was the health clinic director, he used his provider number to bill his patients for medically unnecessary physical therapy, diagnostic testing and other services which were actually provided by an unsupervised physician assistant. (That makes you feel comfortable, doesn’t it?)(I’d say that’s a pretty fair sentence for his crime as long as he pays it all back.)

Fraudsters sometimes wrongly assume that the government doesn’t have time to shuffle through all of the insurance claim paperwork that passes through the Centers for Medicare and Medicaid Services. In this case, the Medicare Strike Force made certain that this ‘No Show’ doctor is now a ‘No Go.’ This doctor was certainly old enough to know better, and it looks like he’s going to be spending most of his golden years trying to make up for his criminal actions.

Source: Today’s ”Fraud of the Day” is based on a press release titled ”’No Show’ Doctor Pleads Guilty In Connection with $13 Million Health Care Fraud Scheme’, ” issued by the Department of Justice on December 1, 2014.

BROOKLYN, NY – Connecticut resident Dr. Okon Umana, 67, pleaded guilty today in federal court in the Eastern District of New York to conspiring to defraud the United States in connection with his role as a ”no show” doctor in a $13 million health care fraud scheme. Dr. Umana is the last of nine defendants charged to plead guilty in connection with the scheme at the Cropsey Medical Care PLLC clinic in Bensonhurst, Brooklyn.

Today’s guilty plea was announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division; George Venizelos, Assistant Director-in-Charge, Federal Bureau of Investigation (FBI), New York Field Office; and Thomas O’Donnell, Special Agent-in-Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG).

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Larry Benson
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.