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Stethoscope on 100 dollar bills symbolizing financial surveillance

Fraud is not new. The first registered case of fraud can be found in 3000 BC when Greek sea merchant Hegestratos took an insurance policy against his ship and cargo and purposely sunk it to collect off his loss. Let it be noted, that Hegestratos was chased by the ship of an angry mob and drowned. Too bad it isn’t accepted now a days for victims of fraud to be able to chase down the fraudster! Would there be less fraud?  Would Rhonda Sutton not have committed Medicare fraud if she knew she would be punished by her victims?

Rhonda Sutton of Illinois worked as an unlicensed medical assistant from 2009 to 2012. During this time, Sutton conspired with two home health care business owners to fraudulently certify Medicare beneficiaries for home health services that they were not eligible for. Specifically, Sutton forged her physician employer’s signature on certification forms and supporting documentation, which caused Medicare beneficiaries to be enrolled in over 2,000 episodes of home health care at A&Z and Dominion home health. Sutton provide the forged physician forms to A&Z and Dominion which enabled them to submit claims to Medicare for services that the beneficiaries did not need and were not qualified to receive. A&Z and Dominion received over $6 million from Medicare due to Sutton’s fraudulent conduct.

If a patient’s medical record is compromised by fraud, like Sutton did, it compromises their future care. It could lead to mistreatment, misdiagnosis, a delay in care, or even being prescribed the wrong medication from honest physicians — an error with potentially fatal consequences.

Sutton was convicted of conspiracy to commit health care fraud on November 17, 2022.  Sentencing by the judge (not the victims!) is scheduled for March 16, 2022.

Great job by the Department of Health and Human Services for the investigation into this case.

Today’s Fraud of the Day is based on an article “Illinois woman convicted of $6 million Medicare fraud” published by United Press International on November 17, 2022.

An Illinois federal jury convicted a woman of conspiring to defraud Medicare of over $6 million. Rhonda Sutton, 58, worked as an unlicensed medical assistant for a Chicago physician from 2009 until 2012. Sutton, along with the owners of two home health care companies, fraudulently certified. Medicare beneficiaries for home health services, the Justice Department said on Thursday.

Sutton forger her employer’s signature on certification forms and enrolled Medicare  beneficiaries in over 2,000 home health care episodes at A&Z and Dominion home health agencies. “Sutton provided the forged physician forms to A&Z and Dominion, which enabled A&Z and Dominion to submit claims to Medicare for services that the beneficiaries did not need and were not qualified to receive,” the Justice Department said. “The owners of A&Z and Dominion paid Sutton kickbacks in exchange for the forged physician forms.”

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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.