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, 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.