Crisis of Epic Proportions

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The National Institute of Drug Abuse reports that more than 90 Americans die every day due to opioid drug overdoses. The organization also states that the cost of prescription opioid misuse in the United States alone costs an estimated $78.5 billion a year in healthcare costs, lost productivity, addiction treatment and the involvement of the criminal justice system. There’s no doubt that America is facing an opioid crisis of epic proportions, thanks to fraudsters like today’s doctor from Miami, Florida, who used a variety of ways to victimize his patients for personal financial gain by committing Medicare fraud.

The Floridian physician perpetrated his fraudulent scheme over six years. During that time, he bilked Medicare of more than $4.8 million by partnering with co-conspirators to submit fraudulent claims to Medicare and to prescribe and fill prescriptions for controlled substances such as oxycodone, hydrocodone and alprazolam.

Here’s how the scam worked. The doctor received illegal healthcare kickbacks for referring Medicare beneficiaries to multiple pharmacy owners, who filled unnecessary prescriptions written by the doctor. (He knew that the pharmacy owners billed and received Medicare reimbursements for prescriptions that he wrote, even though many of them were medically unnecessary.)

The doctor also received illegal kickbacks from his partners in crime for signing off on plans of care and medically unnecessary home healthcare services. Another facet of his scheme included writing prescriptions for very expensive name brand drugs used to treat HIV/AIDs, even though he knew that these drugs conflicted with other HIV medications already prescribed to the Medicare beneficiaries. (That’s scary. He was causing harm to his patients which goes against the Hippocratic Oath.)

 He also prescribed controlled substances such as addictive opioids to his patients and patient recruiters in exchange for $100 or $200 in cash. (That makes him a drug dealer.) Today’s article states that the deceptive physician was aware that his patients did not need the controlled substances that he prescribed. (He even admitted to not examining the patients in some cases.)

Then, to drum up more business, he solicited Medicare beneficiary referrals to his own practices from his co-conspirators. (He also submitted claims to Medicare under his Part B provider number even though he had not provided the services.)

The 51-year-old physician from Miami, Florida pleaded guilty to one count of conspiracy to commit healthcare fraud and wire fraud. He was sentenced to 97 months in prison to be followed by three years of supervised release. (The icing on the cake is that he must pay $4.8 million jointly and severally with his co-conspirators.)

 Congratulations to the Medicare Strike Force for knocking out this small, but significant proportion of the opioid epidemic. While, most opioid abuse occurs when patients misuse their prescriptions for chronic pain, this doctor will be effectively prevented from misusing his medical license to victimize patients for personal gain. (What goes around comes around.)

Today’s “Fraud of the Day” is based on a Department of Justice article entitled, “Miami Physician Sentenced to 97 Months for Role in Pain Pill Diversion and $4.8 Million Medicare Fraud Scheme,” released on September 20, 2017.

A Miami physician was sentenced today to 97 months in prison and three years of supervised release, for his role in a $4.8 million health care fraud scheme that involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone and hydrocodone.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Special Agent in Charge Brian Swain of the U.S. Secret Service’s (USSS) Miami Field Office made the announcement.

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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.