The Copay

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Stethoscope on 100 dollar bills symbolizing financial surveillance

On October 19, 2022, Alexander Istomin pleaded guilty to a Medicare scheme that he could not have done without the cooperation of his patients. Istomin was a registered nurse and nurse practitioner who fraudulently billed commercial health insurers and Medicare nearly $4.4 million for services that he falsely claimed to have provided to patients in Rhode Island, New York. The secret to his billing and receiving almost $4.4 million in patient services never provided was in the co-pay.

It is a felony to routinely waive copays for patients. Waiving the copay is illegal and considered health insurance fraud because your office is claiming the wrong charge for services when insurance claims are created. Istomin admitted to a federal judge that he waived copayments for some Medicare patients, despite being aware that waiving copayments is prohibited. By waiving copayments that patients otherwise would be responsible for, Istomin induced (bribed?) his patients not to report his fraudulent billing to Medicare.

Despite buying his patients silence, Istomin’s billing practice also was fraudulent. Istomin’s cases he claimed he met with in person were out of the country at the time of the alleged visits. On many other occasions when he claimed to have been seeing patients, Istomin himself was either in a different state or another country, often times in Russia. The investigation also determined that the supposed office that Istomin maintained in East Greenwich, and to which he had some payments mailed, was a non-existent medical practice at which no medical services were provided.

Istomin also admitted that he carried out schemes in which he would use patient names and information to get prescriptions to be filled at pharmacies. He arranged for those prescriptions to be returned to him so that he could then distribute those drugs to individuals other than those in whose names the prescriptions were filled.

The matter was investigated by the U.S. Department of Health and Human Services.  Great job.

Today’s Fraud of the Day is based on an article “Nurse admits to $4.4M health care fraud scheme” published by Providence Business News on October 20, 2022

A registered nurse and nurse practitioner who fraudulently billed commercial health insurers and Medicare nearly $4.4 million for services in Rhode Island and other states that he never provided pleaded guilty on Wednesday to federal fraud charges and other offenses.

Alexander A. Istomin, 56, admitted that he routinely submitted fraudulent claims for in-person patient services he claimed to have performed at his offices in Rhode Island, New York and Florida, according to U.S. Attorney for Rhode Island Zachary A. Cunha.

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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.