Signing Off On Fraud

A Bettendorf physician who worked for years in emergency medicine in the Quad-Cities has pleaded guilty to 24 counts of health care fraud in U.S. District Court.

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Before signing your name, it’s really important to know exactly what you are agreeing to. An Iowa physician signed off on more than 1,000 prescriptions that caused Tricare, the healthcare program for America’s military members, to be billed for more than $4.4 million in a healthcare fraud scheme that lasted only about two months.

The Bettendorf, Iowa doctor, who practiced emergency medicine for more than 20 years, got into trouble for “knowingly and willingly” signing off on drug prescriptions based on information that had been recorded by workers at foreign call centers. (The problem was that he approved the prescriptions without actually talking to the patient, conducting an exam or reviewing their medical records. So the question is, were they really medically necessary?)

The signed prescription forms were faxed to multiple pharmacies in Florida and California, where they were filled, then mailed to patients. (The physician signed off on 1,375 prescriptions for compounded medicines over a two-month period for 432 patients.) Tricare reimbursed the participating pharmacies for $4,436,190.  

Where this case differs from others is that as soon as the issue was brought to the doctor’s attention, he immediately reported himself to the Iowa Board of Medicine, as well as to other state boards where he was licensed to practice medicine. Further research reveals that he admitted he should have verified that the patients he signed off on had been seen by qualified healthcare providers first. (Here’s a great example of why you need to understand what you’re signing off on before writing your name on something that could have legal ramifications.)

The 45-year-old Iowa physician pleaded guilty to a total of 24 counts of healthcare fraud. He is facing a maximum of five years in prison for making false statements plus three years of unsupervised release, a $250,000 fine and a special assessment of $100 per count.

The physician must also pay $10,000 in restitution to Tricare. (His lawyer defended his client by explaining that during the very brief two-month period, the doctor had made a terrible mistake for which he received less than $11,000 from Tricare. It’s a good thing he realized his mistake and fessed up.) All of the State Medical Boards where he was licensed to practice agreed to allow the doctor to continue practicing medicine. He is scheduled to be sentence in January.

Perhaps this doctor has learned an important lesson regarding practicing medicine. To be a good doctor, it’s important to talk to your patient, examine them in person if possible and review their medical record to understand history. It’s also important to understand what your responsibilities are when participating as a provider for a government healthcare program; otherwise you could risk losing your livelihood for signing off on fraud.

Today’s “Fraud of the Day” is based on an article entitled, Bettendorf doctor pleads guilty to fraudpublished by The Quad-City Times on August 24, 2017.

A Bettendorf physician who worked for years in emergency medicine in the Quad-Cities has pleaded guilty to 24 counts of health care fraud in U.S. District Court for the Southern District of Iowa, Davenport.

Dr. Paul Matthew Bolger, 45, Bettendorf, pleaded guilty to 18 counts of false statements in health care matters, five counts of introduction of misbranded drugs and one count of making a false statement in health care matters in California, which was transferred to Iowa.

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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.