Brace Yourself

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15815624 - closeup of medicare enrollment form and pen

Medical equipment supply companies depend on doctor referrals for a steady stream of business. Today, we take a look at the former CEO of a Brentwood, Tennessee-based pain management clinic who provided many referrals to the head of a local medical supply company in exchange for illegal kickbacks. The two fraudsters who conspired to commit Medicaid fraud went as far as to forge the signature of a deceased patient so they could collect a total of $4.6 million in Medicaid benefits they did not deserve.

The doctor in today’s fraud case was head of one of the largest pain management chains in the country, operating 60 clinics across 11 states. Unfortunately for patients and employees, the company which was headquartered in Brentwood, Tennessee, shut down abruptly without much warning because of the Medicaid fraud scheme. The article states that the company did not release patient medical records, which made it almost impossible to obtain prescriptions at other clinics. (That’s a serious hardship for patients who rely on pain medication to function.)

To keep her business running, the head of the medical supply company paid kickbacks to the doctor in exchange for referrals of patients who needed medical devices such as knee and back braces. (She filed about $4.6 million in fraudulent Medicaid claims. That’s a lot of knee and back braces.)

The ruse was exposed when federal authorities obtained an electronic paper trail citing their plans to use a deceased patient’s signature to continue billing Medicaid. The intercepted communication became central to the prosecution and was read during a court hearing. (That had to be very embarrassing.) In a nutshell, the medical supply company executive typed an email to one of her employees saying, “I’m going to cheat. Don’t tell anyone.” (Not a wise idea if you don’t want to be caught.) The medical equipment supply company executive also wrote that a patient had died and that she would fake their signature to secure a delivery ticket for medical equipment. (That email was basically her confession to the crime.)

The 71-year-old medical supply company executive from Tennessee pleaded guilty to Medicaid fraud and is awaiting sentencing. The 41-year-old Brentwood-based pain management clinic executive also pleaded guilty in the case for accepting $770,000 in bribes. (Instead of providing braces to Medicaid beneficiaries, they are now bracing themselves for what will most likely be a significant amount of time behind bars and restitution.)

Today’s “Fraud of the Day” is based on an article, “Health care CEO: ‘I’m going to cheat. Don’t tell anyone.’,” posted on Tennesseean.com on February 4, 2019.  

Federal court records have revealed new details and eye-raising emails in the case of two Middle Tennessee health care CEOs who allegedly plotted to forge the signature of a dead patient and used illegal kickbacks to defraud Medicare out of millions.

John Davis, 41, the former CEO of Comprehensive Pain Specialists, and Brenda Montgomery, 71, the head of CCC Medical, were indicted last April by federal prosecutors. Montgomery pleaded guilty to fraud in January and is awaiting sentencing. Davis has pleaded not guilty to all charges.

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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.