Common Denominator

New Medicare Card ++First one rejected for Copyright Trademark issues. Please let me know what I need to remove or alter. Is it the DHHS LOGO? Card design curve? Part of number shown? You accept Social Security cards with the same logo. This was accepted in 2018. iStock # 653549364. Just let me know how to get the new card accepted… thanks!++++

What does Durable Medical Equipment (the equipment ordered by a health care provider for the patients everyday use such as oxygen equipment, wheelchairs and crutches) and Genetic Testing (a medical test that determines a genetic condition or disorder) have in common? In this case? Fraud.

On June 21, 2022, Dr. Patrick Finney admitted guilt in court to violating the False Claims Act, knowingly using false records and statements to get payments from Medicare and conspiring to defraud Medicare by causing the submission and payment of false claims. Those are fancy words that mean Dr. Finney stole the identities of Medicare patients and wrote prescription orders for DME and DME and genetic testing items and services without ever meeting or talking to these patients.

According to prosecutors, Finney entered into financial arrangements to provide clients of physician staffing firm Barton Associates with telehealth services related to the referral of Medicare patients for durable medical equipment and genetic testing items. Finney received illegal compensation from Barton Associates and its telehealth clients in exchange for referring Medicare patients for those services. Prosecutors say that that arrangement is a violation of the Anti-Kickback Statute.

Finney admitted that he knowingly submitted or conspired to submit more than $3 million in false claims to Medicare. According to the False Claims act he’s liable to the United States for over $11 million because the act allows for damages totaling three times the amount of money the government lost, plus penalties. But a stipulation and order Finney signed admitting to the Medicare fraud allegations allows him to fulfill his obligation by paying $561,800. Why is the restitution less than the amount defrauded? There is no answer to that.

Commendable job by Health and Human Services Office of Inspector General for their outstanding work in this case.

Today’s Fraud of the Day is based on an article “Paducah doctor to pay $561,800 for defrauding Medicare” published by Sun Staff on June 23, 2022

A local doctor has agreed to pay $561,800 to resolve allegations of knowingly submitting fraudulent or false claims to Medicare, using and making false records and statements to obtain payment and conspiring to defraud Medicare by causing the submission and payment of false or fraudulent claims, according to a U.S. Department of Justice news release.

According to the government’s complaint, Patrick C. Finney, in violation of the False Claims Act, from at least Nov. 16, 2017, through Aug. 28, 2020, participated in and accepted illegal kickbacks in exchange for ordering durable medical equipment for 1233 Medicare beneficiaries and genetic testing for 386 Medicare beneficiaries, defrauding Medicare for $3.67 million.

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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.