The Dangling Carrot

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There are lots of ways to motivate action. Incentives, such as cash or luxury items, can definitely encourage people to perform better. (Dangling an expensive ”carrot” in front of some people can motivate them to perform better; however, it can also backfire, causing others to commit a crime in order to get what they want.) Likewise, fear can also cause people to take action. An article published in The Chicago Sun-Times explains how one doctor was motivated by fear to defraud the Medicare program. (The dangling carrot in this case was $4 million in Medicare reimbursements.)

The story states that a suburban doctor, who was an employee and part owner of a business that provided comprehensive medical care to homebound patients, received referrals from other home health agencies in exchange for providing certification that the patients were confined to their home. (This is a good example of quid pro quo gone wrong.)

Apparently, over about three years, the doctor falsely provided confirmation that patients were homebound when in reality, 20 percent were not. Regardless of the fact that many of the services were not medically necessary, the physician billed Medicare as if they were, and subsequently he received $4 million from the government health care benefits program.

The 62-year-old pleaded guilty to Medicare fraud and now faces up to 10 years in prison. (That is probably not the way he envisioned spending the last few years of his career.)

The author of the article explains that the doctor was fearful that if he stopped providing the fake certifications, the referrals would stop. (Obviously, letting his fear spin out of control, he most likely thought his business would fail. Perhaps it was the doctor’s lifestyle that motivated him to continue the illegal scam.) Because of this criminal’s actions, Medicare paid more than $20 million for the fraudulent certifications. (That’s a lot of money that didn’t reach those who qualified to receive medical assistance.) There’s a good chance that this man’s worst fears have come to fruition now that he is facing a lengthy term behind bars.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Bloomingdale Doctor Pleads Guilty to Medicare Fraud,” published by The Chicago Sun-Times on September 8, 2015.

A northwest suburban doctor pleaded guilty in federal court Tuesday to a Medicare fraud scheme that caused losses to the program of at least $4 million.

Dr. Arthur Davida, 62, who was an employee and part-owner of Bloomingdale-based Home Care Physicians Inc., pleaded guilty to the health care fraud charge and faces up to 10 years in prison, according to a statement from the U.S. Attorney’s office.

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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.