Feeling the Pain of Fraud

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It ‘s very important to monitor a patient during and after surgery. From the time that patients are put under anesthesia and wake up post-surgery, they need to be monitored. A Georgia doctor, who was responsible for performing surgical monitoring services billed multiple federal insurance programs for medically unnecessary diagnostic tests and services he did not actually perform.

While the doctor was supposed to be monitoring the neurological health of his patients who were undergoing surgery, he allowed an unqualified medical assistant to do so instead. The medical assistant logged in to the hospital or surgical center system using his credentials, giving the appearance that the doctor was monitoring the patient, when he was not. At the end of each surgery, a report was provided and was used to bill patients and health insurance companies.

For more than five years, the doctor caused false claims to be submitted to Medicare, Georgia and Kentucky Medicaid programs, TRICARE and the Federal Employees Health Benefits Program. In addition to not providing surgical monitoring, the doctor also performed medically unnecessary balance tests, nerve conduction and electromyography procedures and drug screens. (Let ‘s see, what else can I bill the government for?)

The 55-year-old physician pleaded guilty to health care fraud and agreed to pay $20 million to resolve charges that he violated the False Claims Act. He is required to sell all but one of his residential and commercial properties, two boats, four jet skis and hand over the proceeds to the government. (Getting a picture of what he was doing while he should have been monitoring his patients?) Let ‘s hope the $20 million price tag on this fraud is painful enough to get this fraudster ‘s attention so that he will never put his patients or taxpayer dollars at risk again.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Doctor from Cumming to pay $20 million after health care fraud,” published by Forsyth County News on February 9, 2017.

A Forsyth County doctor who pleaded guilty to health care fraud in March and was sentenced in October has agreed to pay a $20 million consent judgment to resolve charges that he violated the False Claims Act.

On Thursday, Feb.2, Robert Windsor, 55, of Cumming, agreed to the deal, which will require him to sell all but one of his residential and commercial properties and give the net profits to the government.

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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.