Balancing the Scales

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It’s no fun to be dizzy—whether the condition is caused by a virus, standing up too quickly or amusement park rides—dizziness causes nausea and no one likes to feel sick and unbalanced. An article in the Houston Chronicle tells about a doctor who used the dizzy states of many patients to steal from the Medicare and Medicaid programs. She was one of four doctors charged with bilking the government out of $3 million. (That amount of money could definitely make someone swoon.)

The story states that the doctor in this particular case billed patients for hundreds of vestibular tests which are used to detect inner ear or brain issues that cause vertigo or dizziness. (The problem was that the tests were ordered by unlicensed personnel and sometimes were unnecessary or not performed at all.)

Over four years, the female doctor submitted $653,970 in fraudulent claims to Medicare and Medicaid for the tests. The government paid about half of those claims. (The article also states that the doctor received 23 percent of her practice’s income from these fraudulent tests.)

This doctor was one of four involved in the scheme master-minded by a co-conspirator who actually had no medical training at all. The mastermind, who did business with two health care and rehabilitation centers in the Houston area, enlisted the four doctors—all from the same Nigerian community—to participate in the scam. (He received more than $100,000 in payments just from the doctor described in this article.)

The 44-year-old female doctor—who has five children ranging from 12 to 21—was convicted by a jury on six counts of health care fraud and one count of conspiracy. She was sentenced to three-and-a-half years in federal prison for ordering tests and treatments that patients did not need or receive. (As you might guess, her medical license was suspended by the Texas Medical Board.)

The mastermind got a reduced sentence of just under three years by pleading guilty on all counts for each of the four doctors’ indictments. The other three doctors plus three other employees also pleaded guilty to their involvement in the scheme and have all been sentenced.

The female doctor’s defense attorney declared that she was ”willfully blind” to what was going on and she testified that she was unaware of the fraud. Regardless of her testimony, the doctor’s lack of attention to her office’s billing practices did not convince the judge of her innocence. (As usual, scales of justice were balanced when the judge delivered an appropriate sentence for the crime. Here’s hoping this doctor can regain her balance and learn from her mistake.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Houston doctor sentenced to prison for Medicare fraud,” published by the Houston Chronicle on March 24, 2016.

A Houston doctor was sentenced Thursday to three and a half years in federal prison for fraudulently billing Medicare and Medicaid for hundreds of thousands of dollars in treatment and tests that patients didn’t need or never received.

The sheer quantity of tests, prescriptions and bills generated by Enyibuaku Rita Uzoaga “exceeded that of any physician I’ve ever heard of, any of us has ever heard of,” U.S. District Judge Ewing Werlein Jr. said before issuing the sentence.

Uzoaga’s office submitted $653,970 in claims to Medicare and Medicaid between 2006 and 2010 for vestibular tests, which are used to diagnose vertigo or dizziness. About half the claims were paid.

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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.