15,000 Trips to Nowhere

42864818 - red office folder with inscription claims on office desktop with office supplies and modern laptop.

Taking a trip to nowhere is popular within the cruise industry. The idea is to set sail on a luxury cruise liner for several days of stress free sailing and relaxing with no particular destination in mind. An Arizona man, who owned a medical transport company, took the idea of a trip to nowhere to another level by submitting more than 15,000 falsified claims for ambulatory trips that never happened.

The medical transport owner scammed the Arizona Health Care Cost Containment System (AHCCCS) – the state’s Medicaid program – which reimburses private contractors for transporting Medicaid patients to and from medical and dental appointments. He submitted 15,327 false claims and collected $1.2 million from Medicaid for trips that didn’t take place.

Court records show that in one instance, the owner billed for more than 300 trips in one day. (Did he really think no one would notice?) He also had a habit of billing for trips on Sunday. (Most outpatient medical offices are closed on Sunday.)

Investigators discovered the fraud through the process of claims analysis. (There were no corresponding medical or dental records that showed services were provided on the dates and times he claimed he had transported patients.)

The fraudster was convicted on 35 counts of health care fraud and four counts of identity theft by a federal jury. He is scheduled for sentencing. The government will seize two homes the medical transport owner acquired from the proceeds traced to this crime. In addition, the government will seize five bank accounts with balances ranging from $3,209 to $183,187.

The fraudster tried to take the government on a ride with this fraudulent scam, but it looks like the government may be taking him on a ride to somewhere he doesn’t want to go. Congratulations to the AHCCCS for increasing their resources to specifically focus on non-emergency transportation fraud. (They conduct regular audits and analysis of billing patterns.) This conviction drives home the government’s attitude toward medical transportation fraud – no more free rides.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Mesa man who owns medical-transport company convicted of bilking AHCCCS of $1.2M,” posted on AZCentral.com on December 16, 2016.

A federal jury has convicted the owner of a Mesa medical transportation company of health-care fraud and aggravated identity theft after he billed Medicaid for thousands of trips that never occurred.

Elseddig Elmarioud Musa, owner and operator of Arizona One Medical Transportation, was convicted Dec. 9 in U.S. District Court on 35 counts of health-care fraud and four counts of aggravated identity theft. He is scheduled to be sentenced March 6.

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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.