Fraud Is Not Pain Free

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education, business, fail and technology concept - african american businesswoman or student with laptop computer and papers at office

Chiropractors use spinal manipulation and other alternative treatments to correct subluxations, or misalignments of the vertebrae. A chiropractor from Brentwood, Missouri used his practice to manipulate the federal government into paying for a bogus ankle orthotic that was never delivered. He probably thought he could slip the fake claim under the radar, but ended up committing Medicare Fraud. (Note that it only took one fake claim to cause a lot of pain for this manipulative chiropractor.)

 The idea behind chiropractic care is that through the manipulation of the body’s musculoskeletal structure, the body can heal itself without needing surgery or medication. While the majority of chiropractors are honest, law-abiding, and provide great care, all it takes is one misaligned chiropractor to cause a problem that sullies the reputation of the alternative treatment profession. (This man’s moral compass was out of alignment when he submitted the false claim to the government healthcare program.)

 The licensed chiropractor from Illinois, who operated out of two locations, pled guilty to Medicare Fraud for submitting a false claim for an ankle orthotic in 2013. (While this was his first brush with the law, the judge made an example of him.) He was sentenced to six months of home confinement, five years of probation, a $100 special assessment, a $10,000 fine and $8,221.30 in restitution. While he filed only one false claim for one ankle orthotic, he agreed to pay mandatory restitution to Medicare for all ankle orthotic claims totaling $5,2338.25. He also agreed to pay voluntary restitution of $2,883.05 to three private insurers. (Oh, and his license was suspended indefinitely in Illinois.)

While you may think that this punishment made an impact on the 46-year-old chiropractor, it’s not the end of his manipulative story. Further research shows that he didn’t let the Medicare Fraud conviction tie him down. He resumed work at a medical weight loss center he owned in the St. Louis area of Missouri and used dinner presentations to attract patients to a “breakthrough treatment” that could relieve pain through stem cell injection therapy. (While the therapy was claimed to be FDA-approved, it was not. Do you get where this is going?)

You can read the experience of one patient that did not end well with this promising revolutionary treatment here. When the treatment did not work as promised, she requested her money back. (But, the doctor was nowhere to be found. Perhaps she should have connected the dots between receiving stem cell shots in a weight loss clinic from a chiropractor before she agreed to have the “therapy.”)

 Needless to say, this unlicensed chiropractor has a few lawsuits pending. While chiropractic services can relieve pain for many patients, this fraudster used his title to steal taxpayer funds from the federal government instead of helping relieve discomfort. It looks like this criminal did not learn from his first encounter with the Justice system. It won’t be long before he will have to account for his recent alleged activities regarding stem cell injections. (I’m going to guess that his career is pretty much over.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Chiropractor Pleads Guilty and Sentenced for Making False Claims to Medicare,” released on October 18, 2017.

James Briggs, 46, of Brentwood, Missouri, pled guilty to an information charging one-count of Making a False Claim against the United States. Sentencing was held immediately after the plea hearing in the United States District Court for the Southern District of Illinois, Don Boyce, United States Attorney for the Southern District of Illinois, announced today. The Court sentenced Briggs to six months of home confinement, five years of probation, a $100 special assessment, a $10,000 fine, and $8,221.30 in restitution.

During his plea hearing, Briggs, a chiropractic physician licensed in Illinois, who operated clinics in Jerseyville and Wood River, admitted that he submitted a false claim for an ankle orthotic to Medicare on October 4, 2013. Briggs agreed to pay mandatory restitution to Medicare for all ankle orthotic claims totaling $5,338.25. Briggs also agreed to pay voluntary restitution to other health care benefit plans including Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Missouri, and United Healthcare for all ankle orthotic claims totaling $2,883.05.

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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.