15,000 Trips to Nowhere

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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, 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.