Abuse of Position


Occasionally acts of fraud are committed by people in positions of power or authority. (Sometimes, those we trust can hurt us the most.) An article published in the Examiner details the story of a licensed physician who took advantage of his position to fraudulently bill Medicare and Medicaid for services that were never provided.

Court records show that over a three-and-a-half year period, the physician submitted bills for medical services provided to patients who actually died prior to the dates claimed. Other claims were filed for services that were supposedly provided during the time the physician was out of the country or in another state. (He’s a pretty efficient doctor if he can be in two places at one time.) In some instances, the fraudster’s claims showed that he worked more than 24 hours in one day. And even though he saw some patients in nursing homes, the doctor billed for visits to his patients’ residences. (He could charge higher fees for house calls.)

The physician pleaded guilty to one count of mail fraud for using the U.S. Postal Service to carry out his Medicare and Medicaid fraud scheme. The 48-year-old man was ordered to prison for three years and one month. He will also pay a $10,000 fine and restitution of $370,638.28 to both benefits programs.

Doctors take a Hippocratic Oath for the purpose of agreeing to practice medicine in an honest and ethical manner. (Evidently, this doctor was confused about what the words ”honest” and ”ethical” mean.) This fraudster’s unethical and dishonest behavior abused two government programs that were set up to assist those who deserved the benefits. (In this case, it looks like the doctor is going to get what he deserves. But this time, he won’t be in a position where he can call the shots.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Robstown Physician Ordered to Federal Prison for Health Care Fraud Following Probe,” published in the Examiner on May 17, 2014.

Dr. Roque Joel Ramirez, 48, of Robstown, has been ordered to federal prison following his conviction of mail fraud in connection with his scheme to defraud Medicare and Medicaid through fraudulent billings, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott. Ramirez pleaded guilty Feb. 18, 2014.

Today, Senior U.S. District Judge Hayden Head, who accepted the guilty plea, handed Ramirez a sentence of 37 months in federal prison. He was also ordered to pay a $10,000 fine and $370,638.28 in restitution to Medicare and Medicaid and will be required to serve three years of supervised release following completion of the prison term. In handing down the sentence, Judge Head noted how Ramirez had abused his position of trust within the health care community.

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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.