Nothing New Under the Sun

37175318 - medical team examining patient in hospital.

Skin cancer can be life threatening. (Obviously, that is why it’s important to use sunscreen and cover up when outside to protect your skin from the sun’s dangerous rays.) An article published in The Vero Beach Press Journal shows that there is really nothing new under the sun when it comes to fraud in the Medicare system. The story explains how a plastic surgeon took advantage of some of his patients by billing the government benefits program for unnecessary procedures related to skin cancer.

According to the story, two people filed a lawsuit against the plastic surgeon stating that he violated the False Claims Act by billing Medicare for procedures that he did not actually perform or were not medically necessary. (The whistleblowers included another doctor who referred patients to the plastic surgeon and a woman who previously worked for eight years as a technician in the office run by the plastic surgeon.) Further research on the case revealed allegations surrounding the complex surgery of removing skin cancer. (Perhaps his patients didn’t have skin cancer at all.)

The plastic surgeon agreed to pay $4 million to settle the allegations that his office improperly submitted bills to Medicare. As a result, he is banned from participating in Medicare, Medicaid and any federally funded health care program for at least five years. (How about never again?)

In this case, it wasn’t the sun’s dangerous rays that were the problem, but the doctor who used them as an excuse to steal millions of dollars from the Medicare program. (How many patients had to suffer through unnecessary painful medical procedures?)

The two whistleblowers will split $920,000 as part of the settlement. (Not a bad reward for telling the truth.) Because health care costs continue to skyrocket in part due to the amount of fraud against government programs, whistleblowers are often the best weapon against the illegal actions. Because two people were willing to stand up for what is right, the government was able to cut out this doctor’s fraudulent actions so that Medicare beneficiaries can continue to receive the care they deserve.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Vero Beach Surgeon to Pay $4 Million in Medicare Fraud Lawsuit,” written by Michael Allen and published by The Vero Beach Press Journal on June 17, 2015.

VERO BEACH — A Vero Beach surgeon Wednesday agreed to pay a $4 million settlement in a Medicare claim case, according to a U.S. attorney’s office news release.

The lawsuit claimed that Donald Proctor Jr. of Grove Place Surgery Center in Vero Beach violated the False Claims Act by billing Medicare for procedures that Dr. Proctor either did not perform or that were medically unnecessary, according to the release.

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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.