Because I Told You So

13692877 - a hospital bed waiting the next patient.

Let’s regress back to our childhood for just a moment. Remember some of the unfair rules: (1) no dessert unless you eat all of dinner, (2) no hitting your sibling, (3) no staying up late on school nights and so on. During the protest to our parents the infamous question of ”why” was often answered with, ”because I told you so,” or, ”because I said so.’? Once those words rolled off your parents’ lips, the decision was final. According to an article in the Post-Tribune, a similar case of ”I told you so,” may land one Illinois man behind bars.

When you visit a doctor, or even work for one, you are expected to take their orders seriously. In our society, we hold the opinion/direction of doctors in high regard. When a doctor says ”do,” we typically don’t say ”no.” (In the case of our fraudster, ”no” would have saved him money and possible jail time.) In Hammond, Illinois, an office manager of a local doctor’s office pleaded guilty to billing Medicaid for patients that the office’s doctor did not see or treat, with the approval of the doctor. (Because the doctor told me so, your Honor.) The fraudster was charged with one count of health care fraud because it was discovered that he billed 40 to 50 patients who were not seen in the same day, under the direction of the office doctor.

In court, the fraudster explained? ”Nobody was forcing me to do this. I could have told my boss no.” He explained that on July 21, 2011, his boss called him at the office around noon to explain she would not be coming in for the remainder of the day. She directed the office manager to see her patients and to call her if any prescriptions needed to be written/changed. In actuality, the fraudster saw about 10 patients in the office, although he reportedly billed Medicaid for 40-50 individuals. Not only is it illegal to bill Medicaid for individuals who do not see a doctor/receive treatment, but it is illegal for the office manager to bill Medicaid without the doctor present in the office. The fraudster made a plea agreement that requires him to pay Medicaid $2,831 in restitution, as well as cooperate with the government. Under the agreement, he faces a maximum of 10 years in prison. (A max of 10 years for one afternoon of ”because I told you to.”)

I think I’d prefer a tough round of dodge ball to the game of fraud. I can hold my own out on the court, dodging and throwing. As for the fraudster it’s lights out, game over, thanks for playing and onto sentencing.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Guilty Plea Offered in Hammond Medicaid Fraud; Office Manager Faces 10 Years,” written by Teresa Auch Schultz and published by the Post-Tribune on May 29, 2013.

The office manager for a Hammond doctor admitted Wednesday that he billed Medicaid for patients the doctor never saw but said he did so with his boss’ knowledge.

Kenneth Robinson, 35, pleaded guilty during a hearing at the U.S. District Court in Hammond to one count of health care fraud.

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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.