Quid Pro Quo

52342343 - nurse taking care of sick elderly patient at home

The Latin term “quid pro quo” translates into “something for something.” (In other words, it means, “if you scratch my back, I’ll scratch yours.”) A New Orleans, Louisiana woman committed Medicare fraud through a quid pro quo arrangement involving two Louisiana psychiatrists. While no back scratching was involved in today’s case, she did pay kickbacks in exchange for referrals to her home healthcare agency. (Essentially, they entered into an agreement to steal from the government healthcare program.)

Over five years, the New Orleans woman paid kickbacks to the two psychiatrists with offices in New Orleans and Kenner. (The psychiatrists were affiliated with an outpatient psychiatric services company.) They agreed to accept the bribes in exchange for referring mental health patients from their practice for home healthcare services. Another co-conspirator who worked with the psychiatrists was a marketer who negotiated the kickbacks and made sure the psychiatrists received their payments from the home healthcare provider.

According to evidence presented in court, in addition to the kickback scheme, the New Orleans woman illegally used the Medicare identification information of three Medicare beneficiaries that were connected to the fraud scheme. (Then she lied to federal investigators when questioned about her purported unlawful conduct.)

The 51-year-old woman from Gonzales, Louisiana was convicted on one count of conspiracy to pay and receive kickbacks, three counts of receiving kickbacks, three counts of identity theft and one count of making false statements to federal agents. She was sentenced to 51 months in prison for her involvement in the nearly $2 million home health kickback scheme. (The judge ordered her to pay back $1.958 million in restitution.)

The New Orleans woman had a co-conspirator at the home healthcare agency who assisted with submitting claims to Medicare. The 65-year-old from Harvey, Louisiana caused the government healthcare program to pay more than $1.9 million for the illegally-obtained referrals. The co-conspirator pleaded guilty to Medicare fraud and is currently awaiting sentencing. The two psychiatrists and the marketer have been charged with healthcare fraud.

Medicare fraud is a white-collar crime that costs the government tens of billions of dollars each year. The illegal quid pro quo arrangement that targeted mentally ill Medicare patients in the New Orleans area was effectively shut down by the Medicare Fraud Strike Force. You could say the government’s quid pro quo arrangement provided a successful prosecution and conviction in exchange for the criminal acts perpetrated by the fraudulent home healthcare provider in Louisiana. (Instead of kicking back and enjoying the money she stole from her victims, she may very well be kicking herself for coming up with the idea to scam Medicare in the first place.)

 Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, New Orleans Area Woman Sentenced to More Than Four Years in Prison for Role in Approximately $2 Million Home Health Kickback and Identity Theft Scheme,” released on January 4, 2018.
A New Orleans woman was sentenced today to 51 months in prison for her involvement in a $2 million home health kickback scheme carried out through a New Orleans area home health agency.

Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Acting U.S. Attorney Duane A. Evans of the Eastern District of Louisiana, Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office made the announcement.

Previous articleImpaired Thinking
Next articlePiggy Bank

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.