Fraud Therapy


Have you have suffered an injury that required medical attention? If not, the process of doctor appointments, casts/braces and physical therapy are probably familiar to you. Here’s a little background. Let’s say that you injure your knee playing basketball. Naturally, you call a sports medicine doctor to take a look at the problem. At your doctor’s visit you experience the usual bending and pulling of the knee, sometimes accompanied by an X-Ray. After a diagnosis, the doctor gives you some type of knee brace and/or prescription for physical therapy, bills your insurance and you are on your way. According to an article on one Ohio doctor took advantage of diagnosing patients and billing Medicare for items not necessary to their injuries.

When you go to a doctor, you are trusting that that doctor will give you an honest diagnosis and file the proper billing with your insurance; however, many patients have a different experience. A Cleveland chiropractor was sentenced to two and a half years in jail for his role in a $1.8 million health care scam. (For $1.8 million that doctor better be able to work wonders.) The fraudster pleaded guilty to seven counts of health care fraud after court documents revealed his process for overbilling on medical equipment and treatments. A U.S. Attorney commented? ”This doctor took advantage of programs designed to provide care and support for the old and the sick.” (He might care FOR patients, but he clearly doesn’t care ABOUT his patients.)

Could it be the doctor was just doing his job by ordering the best for his patients? (Right, he seems like a standup character.) Investigators discovered the doctor did business under two entities, though both the companies were located at the same address. Officials explained he ordered custom-molded ankle-foot orthotics for patients who did not need them, billing Medicare and insurance for $2,770 to $4,300 for each pair of boots. In addition, he provided the most expensive back braces to patients without a medical necessity for them, billing Medicare and insurance for $995 to $1,250 for each brace. (You pulled your back out? Let me just grab you a generic $1200 back brace for your temporary soreness.) He also billed for supervised physical therapy to patients who often had unsupervised physical therapy, often charging for an hour of therapy for patients who only had 30 minute therapy sessions. A U.S. Department of Health and Human Services special agent in charge stated? ”The doctor chose to exploit Medicare and other insurers for illegal personal gain and paid the price for his criminal acts.” (Only 2 years for $1.8 million seems like a light sentencing to me.)

It seems like this guy should be less worried about therapy for his patients and more worried about entering therapy to help his problem with fraud. Oh wait, he was involuntarily sent to a therapy for that – we call it ”jail.’? Happy self-fixing Dr. Fraud.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Medina Chiropractor Sentenced to Federal Prison for $1.8 Million Health Care Fraud,” written by James F. McCarty and published by on May 10, 2013.

CLEVELAND, Ohio — A federal judge today sentenced a Medina chiropractor to 2-1/2 years in prison for overbilling Medicare and insurance companies more than $1.8 million for unnecessary medical equipment and treatment, said U.S. Attorney Steven Dettelbach.

Dr. John Heary, 39, had previously pleaded guilty to seven counts 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.