Death Sentence

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Partial hospitalization programs (PHPs) are structured mental health programs that provide outpatient services in lieu of inpatient psychiatric care. Medicare covers PHP services when provided through a hospital outpatient department or a community health center. In today’s ”Fraud of the Day,” a Federal Bureau of Investigation (FBI) press release details what happened to a former hospital assistant administrator who took advantage of his position and tried to steal more than $116 million from the government health care benefits program.

The story states that the former assistant administrator oversaw many of the PHPs at a Houston-area hospital. He accomplished his fraudulent scheme by paying kickbacks to his co-conspirators – patient recruiters as well as owners and operators of group homes – in exchange for ineligible Medicare beneficiaries. (The fraudster submitted claims for PHP services that were not medically necessary and usually not provided.)

The 65-year-old man pleaded guilty to conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and paying illegal kickbacks. He was sentenced to a hefty 40 years in prison and ordered to pay restitution of $31,321,200.

For more than four years, the fraudster also had help from nine co-conspirators including the hospital’s former president and his son, a patient file auditor, group home operators and patient recruiters. They have all pleaded guilty to their parts in the scheme.

Congratulations to the Medicare Fraud Strike Force for bringing down this heavy hitter and prosecuting to the full extent of the law. This fraudster has essentially received a death sentence and it looks like he will be spending his retirement years locked up behind bars. (Let’s hope this case serves as a deterrent to others who think they can get away with defrauding the government.)

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Assistant Administrator of Riverside General Hospital Sentenced to 40 Years in Prison in $116 Million Medicare Fraud Scheme,” released by The Federal Bureau of Investigation on May 21, 2015.

The former assistant administrator of Riverside General Hospital was sentenced today to 40 years in prison for his role in a $116 million Medicare fraud scheme. To date, 10 individuals have pleaded guilty or been convicted for their involvement in the scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division and U.S. Attorney Kenneth Magidson of the Southern District of Texas 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.