Piggy Bank

11915058 - doctor writing prescription selective focus

Around the 15th century, dishes and pots were made out of a type of clay called “PYGG.” When people during that day and time were able to save an extra coin or two, they would drop it into their PYGG clay pot. Fast forward a few centuries to where PYGG pots were replaced with piggy banks, in all shapes and sizes. A Danville, Virginia doctor used two government health care programs to fill his own personal piggy bank. Instead of running a legitimate medical practice, he tried to bring home the bacon by committing healthcare fraud. (He did so by lying about the purported services he provided to his patients.)

The doctor, who owned and operated a family medical practice in Danville, not only defrauded Medicare and Medicaid, but additional private insurance companies. (Why not steal from all insurance companies?) He carried out his scheme by double billing patient visits under two different billing codes. Then, he covered up his deceit by recording false information on patient records to back up his bogus claims. (Who knows what medical conditions he concocted to collect the extra income.)

Because the Danville doctor billed for services he didn’t provide, the multiple healthcare programs overpaid more than $990,000. (And, as you might guess, he never reported that extra income on his tax returns. This man not only pigged out on undeserved healthcare payments but also added tax fraud to his scheme.)

Even after he was warned about his billing practices, he continued to defraud the insurance programs. Because the government thought this deceptive doc’s actions were pure hogwash, he was eventually sentenced on one count of healthcare fraud and one count of tax fraud. The 55-year-old fraudster was sentenced to two years in prison and ordered to pay $1,739,194 in addition to repaying $125,789 in investigative costs.

Some piggy banks have a rubber plug on the underside of the ceramic animal where the owner can access the coins kept within. Others don’t have the plug and must be broken to get the content out. Unfortunately for this doctor, who was hamming it up on the generosity of the federal government, now knows how good the government is at rooting out fraud. (The justice system broke the fraudster’s proverbial piggy bank and I’m guessing he is probably now wallowing in self-pity.)

 Today’s “Fraud of the Day” is based on an article entitled, Danville doctor sentenced to 2 years on healthcare fraud, ordered to pay $1.7 million,” posted on WSET.com on January 9, 2018.

DANVILLE, Va. (WSET) — A Danville doctor, who prosecutors said billed various insurers for services he never administered to patients, even after he was warned about the practice, was sentenced on healthcare fraud and tax evasion charges.

The U.S. Attorney announced Edwin L. Fuentes, 55, was sentenced to 24 months in prison.

Previous articleQuid Pro Quo
Next articleLife Line

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.