Privilege vs. Right

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Medicare enrollment form and glasses

It is a privilege to be a healthcare professional in the Medicare program, not a right. When an excluded health care provider blatantly disregards restrictions and bills federal health care programs anyway, they lose their right to participate as a provider. That’s exactly what happened to Phillip Minga, 56, of Amory, Miss., except he kept on billing the government health care program despite being excluded as a legitimate Medicare provider.

In 2016, Minga, who managed or controlled pharmacies in Mississippi and Alabama, signed a written agreement in which he agreed to be excluded from the Medicare Program for 10 years. This agreement stated that Medicare would not pay claims submitted by anyone who employed Ming in a management or administrative role. He totally disregarded this provision and continued to manage and control pharmacies that submitted Medicare claims from 2016 to 2021.

Minga made sure that individuals submitting Medicare enrollment and/or revalidation paperwork for the pharmacies he controlled did not disclose Minga’s ownership interest or managerial role in those pharmacies. During the five-year time span, Medicare paid approximately $16,109,446.67 to the pharmacies in which Minga had an ownership interest or managerial role. (It makes you wonder why he agreed to the 10-year hiatus in the first place. Did he really think he could get away with it?)

Minga pleaded guilty to four counts of health care fraud and one count of conspiracy to commit health care fraud. He received a 6 ½ year prison sentence and was ordered to forfeit $7.1 million and pay more than $16.1 million in restitution. (Let’s hope that Minga now clearly understands that evading a Medicare exclusion is a serious crime with serious criminal penalties.)

Today’s Fraud of the Day comes from an article, “Man sentenced in health care fraud from Mississippi, Alabama,” published by The Dispatch on December 3, 2021.

BIRMINGHAM, Ala. — A federal judge in Alabama on Thursday sentenced a Mississippi resident to 6 1/2 years in prison after the man pleaded guilty to federal charges tied to billing that pharmacies submitted to Medicare.

Phillip Minga, 56, of Amory, Mississippi, managed or controlled pharmacies in Mississippi and Alabama, according to a Justice Department news release. He pleaded guilty in August to four counts of health care fraud and one count of conspiracy to commit health care fraud.

 

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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.