There’s No Substitute for Hard Work

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There are occasions when it’s o.k. to have a substitute. For example, when a teacher is sick it is acceptable to bring in a substitute teacher to lead a class until the regular teacher can return. (But when emergency services are involved, you don’t want to substitute an Emergency Medical Technician (EMT) with someone who doesn’t know how to perform Cardiopulmonary resuscitation (CPR).) The owners of a health care company that provided ambulance services for Medicare and Medicaid beneficiaries used substitute EMTs to qualify for participation in the Medicare program, then they stole more than $6 million through fraudulent claims.

Two brothers owned and operated the health care company behind the gates of an upscale townhouse community in Houston. Their scam was carried out by first using ”stand-in” EMTs not employed by the company to take the tests necessary for certification. Once certified, the company owners proceeded to violate some of the rules set forth to protect Medicare and Medicaid beneficiaries. (It is important to note that Medicare and Medicaid only pay for ambulance services that are medically necessary, mainly for patients who cannot be safely transported any other way. Additionally, Medicare also requires two individuals to staff the ambulance vehicle and at least one of them has to be a licensed EMT.)

It appears that the brothers routinely billed the insurance programs for unnecessary trips. There were reports that individuals who were transported by ambulance were not actually bed bound, they could walk and they used the transport services for their daily activities. Apparently, one patient walked to her own therapy session, yet the ambulance company billed Medicare for more than $51,952. (It sounds like she was transported in a diamond studded limo rather than an ambulance.)

The company also paid a Houston doctor $500 per medical necessity order so they could bill Medicare. (That is definitely the wrong way to get new customers.) There were also many times when the brothers admitted they transported patients without the appropriate number of licensed EMTs on board. (I wonder if they turned on the lights and sirens to bypass a few stoplights if running late?)

The company ended up billing Medicare, Medicaid and also Tricare for a total of $6,293,108 in fraudulent claims that were not actually provided nor medically necessary. (Due to their illegal acts, they received more than $2.4 million from the three insurance providers.)

The 29- and 28-year-old brothers were convicted of conspiracy to commit health care fraud and money laundering. They are each facing up to 10 years in prison for each count or conviction plus a potential fine of $250,000. They both agreed to forfeit the Porsche and Mercedes Benz that were purchased with the illegally gained funds and to pay full restitution to the health care programs. The two men are already in federal custody awaiting sentencing.

These two fraudsters tried to take the easy way out by fraudulently billing Medicare, Medicaid and Tricare for services not performed. Because they substituted laziness for hard work, it looks like they are facing prison labor in the near future. (If fraudsters worked harder at performing legitimate jobs, perhaps there wouldn’t be a need for as many prisons.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Ambulance Company Owner, Brother Convicted in $6 Million Healthcare Fraud,” published on December 10, 2016.

HOUSTON – Two brothers have been convicted on charges of conspiracy to commit healthcare fraud and money laundering, announced U.S. Attorney Kenneth Magidson.

Kevin Olufemi Davies, 29, and his brother Melvin Olusola Davies, 28, owned and operated KMD Healthcare Services Inc. (KMD) from their home in a gated townhouse community in Houston. As part of their guilty pleas, they admitted they used stand-in emergency medical technicians (EMT) who were not employees or affiliated with KMD to pass the state inspection necessary for enrollment in the Medicare program.

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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.