The End of a Fraudulent Career

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Not all crimes lead to time behind bars. But, the alternative punishment for defrauding a government healthcare benefits program can be as equally devastating to the perpetrator’s life as jail. Today’s fraudster is a Stamford, Connecticut dentist who agreed to a settlement that resolves allegations of his participation in a Medicaid fraud scheme involving the submission of false claims for dental services provided to long-term care facility residents. (While his punishment did not include time behind bars, it effectively ends his career.)

The Connecticut dentist and his wife owned four dental companies. One of them was a mobile clinic that provided dental services to senior citizens residing in nursing homes around the state. (He had a habit of billing Medicaid for services he didn’t provide and for dentures that were improperly made and packaged. He pocketed the cash for his own use.)

During one two-month period, he allegedly billed Medicaid and the Connecticut Department of Social Services $25,661 for dental services that were never rendered. Just on one day alone, he purportedly billed the government healthcare benefits program nearly $18,000 for providing 261 dental procedures on 71 patients in four different locations. (That’s pretty darn good considering the man is a septuagenarian. I’m not sure someone even half his age could keep up with that pace.)

After the state’s Department of Social Services (DSS) office paid the dentist’s unusually large bills related to his participation in the Connecticut Medical Assistance Program (CMAP), the organization suspended payment explaining that here were credible fraud allegations against him. Then the state’s Division of Criminal Justice got involved and sent investigators out to the four nursing homes where he claimed he saw 71 patients in one day. (As you might guess, the investigators found no indication that he had been there or saw any of the patients even though he billed Medicaid for $5,682 that particular day.) In reality, he didn’t visit the facilities on the dates he claimed and was even hospitalized during a period of that time.

The dentist and his wife agreed to forfeit $755,956.30 in payments suspended by the DSS to resolve the Medicaid fraud allegations. (Smart move since the evidence seemed to be overwhelming.) In addition, he agreed not to renew his now-expired dental license. Plus, he will not be able to participate in the CMAP program for 10 years.

Fraudsters don’t always have to be put behind bars to suffer the consequences of committing a crime. This elderly dentist has received an effective punishment for preying upon vulnerable citizens who deserved much better treatment than they received. (His career is definitely over. Case closed.)

Today’s “Fraud of the Day” is based on an article entitled, State reaches settlement with Stamford-based dentistposted on HartfordBusiness.com.

A Stamford-based dentist will be excluded from participation in the state’s Medicaid program for 10 years and will agree not to renew his expired dental license as part of a settlement resolving allegations he engaged in a scheme to submit false claims for dental services provided to residents of long-term care facilities in the state.

The announcement was made Tuesday by Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby.

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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.