How Fraud Harms the Patient

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Senior Man in Wheelchair looking out of a window in a hospital corridor.

Jean Skiera didn’t question anything when she got a phone call this past spring that medical equipment was on its way for her husband, Ron, a patient recovering from multiple surgeries. After all, she believed her husband’s doctor knew what was best. Both had questions, however, when the package came containing a back brace, two knee braces, and a pair of knee suspension sleeves which seemed incompatible with Ron’s injuries.

Ron tried the equipment and it felt that they would cause him more injury if he used them and that is when they grew suspicious. Luckily for the Skieras, they followed their instinct and Ron stopped using the braces. Because the equipment was actually props used in a multimillion-dollar Medicare fraud scheme, which they learned about from the news.

Fawn Munro, a nurse practitioner from Michigan working for a telemedicine company, was indicted on July 19, 2022, as part of a large-scale Medicare scam. Munro, allegedly, ordered unnecessary braces without examining patients causing Medicare to pay more than $1.8 million on fraudulent claims.

Did Munro ever consider how she was impacting her victims while allegedly issuing fraudulent orders to Medicare? That is a question that may not get answered when her trial comes up in January 2023. For the Skiera’s, they are thankful Ron didn’t get further injury from fraudulent equipment, but they are upset this equipment couldn’t be sent to someone who needs them. On a fixed income, they also worry of future medical expenses, as beneficiaries who have received unwanted or unneeded braces billed to Medicare may later be denied coverage for legitimate medical needs.

Great job by U.S. Office of Inspector General in this investigation.

Today’s Fraud of the Day is based on an article “Billion-dollar Medicare scheme hits Lachine couple” published by The Alpena News on August 25, 2022LOCAL NEWS

A widespread scam costing billions to health care insurers could be endangering the health of Northeast Michigan residents. When news broke recently of an Alpena nurse facing federal charges for her alleged part in a scheme to defraud Medicare, a Lachine couple realized they were probably victims in a similar scam.

The box of medical supplies that showed up on their doorstep in April, allegedly ordered by a doctor, could have made her husband’s health problems worse, said Jean Skiera. Medicare and a supplemental insurance company paid the cost of the medical braces enclosed in the box, but the couple could have paid with injuries from using the devices without a doctor’s orders or with increased insurance costs, Skiera said.

 

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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.