How to Catch a Psycho Biller

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22477505 - medical and health insurance claim form with stethoscope on clipboard

No one in their right mind would dare submit hundreds of fraudulent bills to Medicaid and expect to get away with it. And yet today’s fraudster accomplished just that. The owner and operator of a social services business that provided psychotherapy to Medicaid beneficiaries defrauded the government health care program of more than $200,000.

Over more than three-and-a-half years, the female company owner and two others conspired to bill Medicaid for psychotherapy services that were either provided by unlicensed providers or weren’t provided at all. Court documents show that a co-conspirator, who owned a separate social services business, also engaged in fraudulent billing practices by allowing her Medicaid provider number to be used by the first business owner to submit fraudulent psychotherapy bills. (Apparently, the owner of the second business kept 30 percent of the proceeds, while the first social services company got 70 percent.)

A jury convicted the first woman of 23 counts of health care fraud plus one count of conspiracy to commit health care fraud. (The 44-year-old business owner who submitted the fraudulent bills originally denied the charges when indicted.) At her sentencing, the 44-year-old is facing up to 10 years on each health care fraud count and up to five years on the conspiracy charge.

Further research revealed that the woman who allowed her Medicaid provider number to be used pleaded guilty to one count of health care fraud. (She stole $214,555 through the scheme and awaits sentencing.) Three other individuals were also charged and convicted of health care fraud resulting from this investigation.

Congratulations to the successful efforts of the Connecticut Medicaid Fraud Working Group, through which federal and state law enforcement plus state agency representatives combined efforts to detect, investigate and prosecute the co-conspirators involved in this case. They stopped these psycho billers from further undermining the financial health of this government health care program and the mental health of those who qualify for and deserve to receive medical care.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Bristol woman convicted of defrauding Medicaid of more than $200 thousand,” posted on fox61.com on May 30, 2017.

BRISTOL — A Bristol woman has been convicted of her role in a scheme that defrauded Medicaid of more than $200,000.

The U.S. Attorney’s office said Tuesday a jury convicted 44-year-old Ronnette Brown, of Bristol, this month of 23 counts of health care fraud and one count of conspiracy to commit health care fraud.

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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.