Bursting Bubbles

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Mature woman with problems.

Acupuncture is a form of Chinese medicine that involves sticking needles in specific areas of the body to treat pain. Practitioners believe that by placing the needles in strategic points, a person’s energy flow will re-balance. The owner of several rehabilitation clinics in California used a fraudulent strategy to cause $2.9 million to flow out of Medicare and into the pockets of the clinic owner and his associates. (The imbalance caught the government’s attention.)

The owner of the rehab clinics carried out the scheme by recruiting Medicare beneficiaries for massage and acupuncture treatments; however, those procedures are not eligible for Medicare reimbursement. Over four years, the owner and his associates submitted bills falsely claiming the patients had received physical therapy, which is covered by Medicare. Prosecutors allege that the clinic owner kept about $1.6 million out of the $2.9 million for himself.

The 55-year-old mastermind was convicted of 19 felonies including health care fraud, making illegal kickbacks and identity theft. He was sentenced to 10 years and one month in prison and must pay $3 million in restitution. Eight associates have also pleaded guilty to their involvement in the scheme and are serving from 15 to 51 months in prison.

But that’s not the end of the story. This fraudster had another scam going on. He also pleaded guilty to health care fraud in a separate case which involved fraudulent claims for occupational and physical therapy services that were never provided. It is estimated that losses from that scheme amount to an additional $2.4 million. He is scheduled to be sentenced.

This fraudster was incredibly cocky and masterminded two schemes that allowed him to steal benefits from people who legitimately qualified for and deserved to have them. This criminal inserted one acupuncture needle too many and burst his narcissistic bubble. He’s going to be in prison for a long time to come. While his energy flow is now out of balance, at least the scales of justice are back in balance in this particular case.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Brea man gets decade in prison in $2.9 million dollar Medicare fraud,” published by The Orange County Register on January 10, 2017.

SANTA ANA – A Brea man who used his rehabilitation clinics to submit millions of dollars in false Medicare claims was sentenced this week to more than a decade in federal prison, even as he awaits sentencing in a second health care fraud case.

U.S. District Judge David O. Carter, during a hearing at the federal courthouse in Santa Ana, ordered Simon Hong on Monday to spend 121 months behind bars and to pay nearly $3 million in restitution, according to the U.S. Department of Justice.

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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.