Powering Down Fraud

66
65037362 - healthcare cost concept with calculator and medical bill

The term ”powering down” generally means to turn something off by shutting down operations in a systematic way. KPIX, the San Francisco Bay CBS television affiliate, reports on a story involving the Federal Bureau of Investigation (FBI) and their recent success at ”powering down” a Medicare fraud scheme, which involved two California-based medical equipment supply company owners and more than 400 power wheelchairs.

The article states that a husband and wife, who owned the two companies, submitted more than $3.2 million in fraudulent claims to Medicare for power wheelchairs and other accessories between 2006 and 2011. They were paid $1.6 million by the benefits program. According to the story, the 51-year-old husband and the 45 year-old wife had several accomplices who helped to recruit patients and to fabricate phony prescriptions for power wheelchairs and other medical equipment. (You guessed it – the wheelchairs were not medically necessary and not wanted in most cases.)

Patients were recruited from several locations within San Francisco neighborhoods, including a fast food restaurant and a senior center. The husband and wife team paid a medical clinic doctor $100 per patient to write fake prescriptions and two other patient recruiters $100 and $50 respectively for each patient referral. The criminal team had a well-oiled fraud machine going. The doctor even took along a portable copier to make copies of patient Medicare cards prior to conducting sham examinations. (A doctor that makes house calls and carries her own copy machine for insurance processing – now that’s service!)

During a 13-day trial, the husband and wife, plus one patient recruiter, pleaded guilty to conspiring to commit health care fraud along with individual counts of fraud. Each count carries a possible maximum sentence of 10 years in prison. The couple was also found guilty of conspiracy to pay and receive kickbacks for the phony patient referrals. The maximum sentence for this charge is five years in prison.

Congratulations to the FBI on their ability to ”power down” this health care fraud scheme. This is another case that proves the government will not tolerate health care fraud.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Trio Convicted in San Francisco Federal Court of $1.6M Medicare Fraud,” published by KPIX, the San Francisco Bay Area CBS affiliate on December 6, 2013.

SAN FRANCISCO (CBS SF) — Two medical equipment supply company owners and an associate have been convicted in federal court in San Francisco of conspiring in a $1.6 million Medicare fraud concerning power wheelchairs.

The three defendants were convicted by a jury on Wednesday after a 13-day trial and will be sentenced on March 20 by U.S. District Judge Jeffrey White.

Read More

SHARE
Previous articleDriving Away Fraud
Next articleNo One Likes a Manipulator

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.