Testing, Testing, 1-2-3

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Corrupt doctor with money in his pocket

No one likes medical tests, especially when it involves needles. Perhaps just as stressful would be a test for a sexually transmitted infection (STI). An Ohio doctor has pleaded guilty for her role in a Medicare and Medicaid kickback scheme that involved unnecessary testing for STIs. (I bet her victims would like to order some unnecessary testing of their own for their “not so trustworthy” physician.)

Dr. Michelle Kapon pleaded guilty to one count of conspiring to solicit, receive, offer, and pay kickbacks in connection with a federal health care program and two counts of receipt of kickbacks in connection with a federal health care program.

Investigators claim that Kapon, 41, of Youngstown, and Dr. Joni Canby, 62, of Poland, received kickbacks from Dr. Samir Wahib after sending samples from their patients to him for gonorrhea and chlamydia testing. (They scared their patients into thinking they may have an STI. Actually, they just wanted to get paid for referring tests to Wahib.)

Wahib allegedly paid $20 in kickbacks to Canby and $15 to Kapon for every specimen they sent to him. Wahib then submitted false claims to Medicare and Ohio Medicaid for payment of the unnecessary tests. Investigators state that the specimens sent to Wahib did not have a medical reason to be tested and were a result of Canby and Kapon’s attempts to increase their own profits. (Does that surprise you? I didn’t think so.)

The government claimed the payments to Canby and Kapon were disguised as “physician coverage” on checks from Wahib’s business account. In total, Wahib paid $31,520 to Kapon and Canby between 2014 and 2017. During this time, Wahib submitted 42 related claims to Medicare and Ohio Medicaid. (All the pieces are starting to come together.)  

Kapon is awaiting sentencing after pleading guilty to conspiring to solicit, receive, offer and pay kickbacks in connection with a federal health care program. Both Wahib and Canby have been indicted by a federal grand jury and await trial. (If I were them, I wouldn’t hold my breath for a positive outcome.)

Dr. Wahib faces 11 counts on charges of Conspiracy to Solicit, Receive, Offer and Pay Kickbacks in Connection with a Federal Health Care Program, Offering or Paying Kickbacks in Connection with a Federal Health Care Program, Conspiracy to Commit Health Fraud, Health Care Fraud, and Obstruction of a Criminal Investigation of Federal Health Care Offenses.

Dr. Canby faces 10 counts on charges of Conspiracy to Solicit, Receive, Offer and Pay Kickbacks in Connection with a Federal Health Care Program, Receipt of Kickbacks in Connection with a Federal Health Care Program, Conspiracy to Commit Health Fraud, and Health Care Fraud.

Usually, it is better to give than receive, but in this case giving and receiving of kickbacks were a very bad thing. (Something tells me these two will get their comeuppance.)

Today’s Fraud of the Day comes from an article, “Valley doctor pleads guilty to Medicaid, Medicare fraud conspiracy,” published by WFMJ.com on February 22, 2021.

A Valley doctor awaits sentencing after pleading guilty to charges filed in connection with an alleged Medicare and Medicaid kickback scheme for testing that was not medically necessary.

Doctor Michelle Kapon appeared through video in U.S. District Court on Monday and pleaded guilty to one count of conspiring to solicit, receive, offer and pay kickbacks in connection with a federal health care program and two counts of receipt of kickbacks in connection with a federal health care program.

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Larry Benson
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.