Go Big…And Then Go To Prison

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16639259 - procedure that makes the doctor

Some people just can never have enough. According to a press release recently issued by the Department of Justice, a high-profile businessman in Tampa was caught leading a group of conspirators through a multi-million dollar scam to defraud Medicare of more than $12 million, by submitting false claims for medical services like radiology, neurology and cardiology. (Arguably, the most expensive services. Go big or go home!)

The group spread the fraudulent claims across three different medical clinics, and used forged or downright false documentation in the clinics’ Medicare enrollment process. They also illegally paid kickbacks to get access to Medicare patients and their personal information. Armed with this data, they submitted claims for patient visits that had never happened or for services that the clinics never actually provided. Finally, they used shell companies and a multitude of cash withdrawals to hide, transfer and share amongst themselves the money that Medicare paid out for the claims. (Fortunately, they did not collect the full $12 million in claims, only a portion had been paid out before they got caught.)

When the federal Medicare Fraud Strike Force did uncover the crime and alerted the Federal Bureau of Investigation and the Department of Health and Human Services Office of the Inspector General, the two agencies commenced an investigation. The probe resulted in federal charges for the ringleader, who was found guilty by a jury of health care fraud, money laundering, wire fraud and aggravated identity theft, as well as conspiracy to commit health care fraud and conspiracy to commit money laundering. In addition to being sentenced to more than fourteen years in federal prison, he was ordered to pay $2,512,460 in restitution.

Anyone who thinks that government officials won’t notice a $12 million dollar increase in claims clearly letting greed get the best of their judgment, especially given the fact that a dedicated task force exists to specifically sniff out such crimes. The Department of Justice cites that the Medicare Fraud Strike Force has filed charges against 2,000 defendants, responsible for $6 billion in fraudulent claims since its inception in 2007.

Source: Today’s ”Fraud of the Day” is based on, ”Florida Man Sentenced to More than 14 Years in Prison for Multimillion-Dollar Health Care Fraud and Money Laundering Scheme,” a press release issued by the U.S. Department of Justice on March 7, 2016.

In December 2015, a jury in Tampa found David Brock Lovelace, 45, guilty of conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to commit money laundering, money laundering and aggravated identity theft. Judge Steven D. Merryday of the Middle District of Florida imposed today’s sentence and also ordered Lovelace to pay $2,512,460 in restitution.

According to evidence presented at trial, from approximately June 2010 through approximately May 2014, Lovelace and co-conspirators used Cornerstone Health Specialists, Summit Health Specialists and Coastal Health Specialists, three purported medical clinics in Florida, to submit approximately $12,351,046 in false and fraudulent claims to Medicare seeking reimbursement for radiology, audiology, cardiology and neurology services. Medicare paid approximately $2,848,424 in reimbursement on the fraudulent claims. Trial evidence also showed that Lovelace and his co-conspirators paid illegal kickbacks in exchange for access to Medicare patients and Medicare patient information used in the fraud scheme, used forged and falsified documents in the Medicare enrollment process for the medical clinics, and billed Medicare for services that had not been rendered by physicians. The conspirators transferred and disbursed proceeds of the fraudulent Medicare claims among themselves, through shell companies and via numerous cash withdrawals in an effort to conceal the fraud, according to evidence at trial.

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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.