The Doctor Is In…Trouble

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Calculator and stethoscope on paperwork

Many hard-working people in the United States can utilize workers compensation when illness or injury strikes, but unfortunately workers compensation claims also provide an opportunity for fraudsters to take advantage of the system. One such fraudster is an Alexandria, La., physician, Robert Clay Smith, who recently pleaded guilty to conspiracy to commit health care fraud, wire fraud and illegal remunerations.

Smith was part of a scheme to defraud both federal and private workers’ compensation insurers after being recruited by a Rogers-based medical supply and billing company. (I guess this is just another day in the life of those committing fraud.)

Smith made more than $650,000 from the scheme, which ran from 2013-2017. The company that recruited Smith had him provide pain creams and patches; despite the fact he did not have a license to dispense medications from his clinic. While this is required under Louisiana law, Smith still dispensed the topical medications from the Rogers company to his workers’ compensation patients from his clinic. (What’s one more broken law when you’ve already broken so many?)

On Smith’s behalf, the Rogers company handled all the paperwork and submitted the allegedly fraudulent claims to both the U.S. Department of Labor and Office of Workers’ Compensation Programs, which covers all federal employees, as well as private insurers. Smith admitted he was paid 50 to 55% of the collected profits from billing insurers at markups of 15 to 20 times of the medication’s cost.

But Smith was not alone in this scheme. Dr. Robert Dale Bernaurer Sr. pleaded guilty to conspiring with the Smith Company in a similar scheme. The company’s former billing director, Amanda Dawn Rains, also pleaded guilty to participating in criminal conspiracies with the two doctors and others.

During his plea hearing, Smith waived indictment by a grand jury and pleaded guilty to all three federal statutes of which he was charged. The court will determine his sentencing at a later date, when he faces up to five years in prison. (I would say that this doctor is definitely in trouble.) 

Today’s Fraud of the Day comes from the press release, “Second Doctor Pleads Guilty to Workers’ Comp Fraud Conspiracy,” published by The United States Department of Justice on March 29, 2022. 

FAYETTEVILLE – An Alexandria, La., physician pleaded guilty today to having conspired to violate three different federal statutes in connection with a scheme to defraud both federal and private workers’ compensation insurers.

U.S. District Judge Timothy L. Brooks presided over the plea hearing, in which Robert Clay Smith, 60, waived indictment by a grand jury and pleaded guilty to a criminal information charging him with conspiracy to commit health care fraud, wire fraud, and illegal remunerations (taking kickbacks).

 

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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.