Keeping Stories Straight

87

When multiple people are involved in fraud, it is important to keep stories straight so suspicions are not raised. An article published by Alaska Dispatch News details what happened when a doctor and his office manager did not tell the same story about their alleged involvement in a $1.2 million Medicaid fraud scheme.

The article states that an Alaskan doctor, who primarily treated children for mental health issues, and his office manager supposedly billed Medicaid for approximately $1.2 million in fraudulent claims. Fortunately, Medicaid did not pay all of the bills.

During a 45-minute conversation, the office manager reportedly was able to capture the doctor admitting to the scheme and emphasizing the importance of telling the same story so that they might ”get past” the inquiry into the alleged fraud. (If true, this is troubling.) The story also mentions that the office manager and an ex-girlfriend testified that the doctor had a tendency to use prescription pills while working and often wrote multiple opiate prescriptions for friends. (Again, if true, that’s an abuse of position.)

The Anchorage doctor pleaded guilty to two felonies, including medical assistance fraud and evidence tampering. He also agreed to a plea deal and will serve time between one to three-and-a-half years in prison. He will be required to complete 10 years of probation, but can apply for early termination after five years if all restitution is paid in full.

The article does not say what happened to the office manager who originally assisted with the fraudulent billings, but it’s safe to assume that his efforts greatly reduced any punishment he would have received if he had continued to cover up the fraud. It just goes to show that the best story anyone can tell is the truthful one. Lying always leads to a bad ending.

Source: Today’s ”Fraud of the Day” is based on an article titled ”Anchorage Physician Pleads Guilty to Medicaid Fraud,” written by Jerzy Shedlock and published by Alaska Dispatch News on December 1, 2014.

Dr. Shubhranjan Ghosh, an Anchorage physician charged with Medicaid fraud totaling more than $1 million, pleaded guilty Monday to two charges as part of a plea agreement.

Ghosh entered guilty pleas for single counts of medical assistance fraud and evidence tampering, both felonies, according to the state’s plea agreement.

Read More

SHARE
Previous articleMaking A Statement
Next articleGuest Writer: Greg Desmarais

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.