Portable Fraud

New Medicare Card ++First one rejected for Copyright Trademark issues. Please let me know what I need to remove or alter. Is it the DHHS LOGO? Card design curve? Part of number shown? You accept Social Security cards with the same logo. This was accepted in 2018. iStock # 653549364. Just let me know how to get the new card accepted… thanks!++++

O’Lear was the president of Portable Radiology Services, a company that supposedly provided portable X-ray services to individuals residing in nursing homes, skilled nursing facilities and long-term care facilities. But the reality of it was that O’Lear only provided portable fraud.

From 2013 through 2017, O’Lear submitted false claims for reimbursement to Medicare and Medicaid for thousands of x-rays and related services that he and his business did not provide, including approximately 151 x-ray services purportedly provided to patients on dates after the patients had died. Fraudsters are partial to dead people since they can’t tattle!

But dates and paperwork eventually raised questions on O’Lear. O’Lear billed Medicare and Medicaid for purportedly having provided x-ray-related services to beneficiaries at nursing facilities on dates when the beneficiaries were hospitalized and not at the facilities. O’Lear also took multiple x-rays that had all been performed in one visit and falsely claimed that each one had been done on a different day, requiring separate reimbursement for transporting the portable x-ray equipment on each date.

An audit from Medicaid found that O’Lear covered up his scheme by creating false medical records, including forms for ordering x-rays and radiology reading reports. He was found to have re-used the same image repeatedly as different images of the same patient and also as images of different patients. In creating the falsified order forms, he forged the signatures of his employees and the physician he said had ordered the x-rays.

As a result of the scheme, O’Lear submitted fraudulent bills to Medicare, Medicaid and Medicaid MCOs for approximately $3.7 million and received approximately $2 million in payments as a result of fraudulent bills. O’Lear was found guilt and on September 29, 2022, sentenced to 15 years in prison and was ordered to pay $1,989,490 in restitution to Medicare, Medicaid.

Great attention to detail by the audit teams of Medicaid and Medicare.

Today’s Fraud of the Day is based on an article “Northeast Ohio man and president of radiology services company sentenced to 15 years in prison following healthcare fraud scheme” published by WKYZ Studios on September 30, 2022

A Northeast Ohio man who was part of a $2 million health care scheme was sentenced to 15 years in prison on Thursday. 58-year-old Thomas O’Lear of North Canton was also ordered to pay $1,989,490 in restitution to Medicare.

O’Lear, the president of Portable Radiology Services (PRS) was sentenced after being convicted of defrauding Medicare and Medicaid of nearly $2 million from billing for x-ray services that his company did not provide. He also was part of a fraudulent cover-up scene to hide the crime and committed aggravated identity theft in doing so.

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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.