Enterprising Fraudster

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Medicaid billing fraud is a lucrative business for enterprising fraudsters. Perpetrators of this type of fraud are counting on patients and Medicaid claims processors to not examine their billing statements too closely. A doctor in Ohio was running a profitable billing fraud enterprise out of a Michigan urgent care facility until someone turned him in.

The former physician submitted claims to Medicaid and Blue Cross Blue Shield for medical services he did not provide while working at the medical facility. After a tip was made to local police, a case was opened by the Michigan Attorney General’s Office to investigate the allegations made.

The physician was charged with 22 counts, but he averted a jury trial by accepting a plea deal where he pleaded guilty to two counts of Medicaid fraud and two counts of health care fraud. Because of his guilty plea to these four charges, prosecutors agreed not to go after him for the other 18 counts, one of which was running a criminal enterprise. (That charge alone could have put him in prison for 20 years.)

The doctor was sentenced to one day in jail, but received credit for the day he had already served. He has already paid fines totaling $278,355 to the State of Michigan. Also, his medical license is suspended pending a hearing before the Michigan Board of Medicine. (It is possible he could lose his license to practice medicine.)

This enterprising doctor had his lucrative operation shut down, but his surprisingly light sentence may encourage him to become a repeat offender. Let’s hope that this is not the case.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Ex-Canton doctor pleads in medical fraud case,” posted on hometownlife.com on February 14, 2017.

A former Canton-based doctor who pleaded guilty in a medical fraud scandal has been sentenced to one day in jail and ordered to pay fines totaling $278,355, a court clerk confirmed Tuesday.

However, Bassel Altantawi of Farmington Hills also has had his medical license suspended as he faces a hearing before the Michigan Board of Medicine, said Michael Loepp, spokesman for the Michigan Department of Licensing and Regulatory Affairs.

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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.