The Facets of Fraud

11742853 - money and pills

Facet joint injections are a minimally invasive way to receive steroid medication directly to the spine that usually spells R-E-L-I-E-F to back and neck pain sufferers. While the treatment can alleviate pain for up to six months in many patients, sometimes, pain medications are also necessary to provide a reprieve from the suffering. A Ypsilanti, Michigan physician committed more than $19 million in Medicare fraud by participating in a scheme that involved unnecessary facet joint injections and prescriptions for controlled substances. (I’m guessing that like most fraudsters, the Detroit-area doctor created pain where there was none to begin with.)

Just as facet joints link each vertebra in the spine together, there are many facets of fraud that link today’s perpetrators together. (Fraud rarely occurs without the assistance from other co-conspirators who join together to steal what is not rightfully theirs.) Today’s article states that a total of seven people allegedly enabled many patients and Medicare to be defrauded through the submission of false and fraudulent claims to various medical providers.

The main fraudster in today’s “Fraud of the Day” is a physician who conspired with a business partner who owned multiple pain clinics where the facet injections occurred. (An important fact to note here is that the proprietor of the pain clinics was not allowed to own the medical clinics by law, so the physician served as the straw owner.)  

The physician submitted more than $19 million worth of fraudulent claims for medically unnecessary facet joint injections and prescriptions for pain medications such as Oxycodone, Hydrocodone and Opana to Medicare beneficiaries. (The sad thing is that some of the patients were already addicted to the narcotics.) He also neglected to disclose that he was not the rightful owner of the pain clinics.

The 72-year-old Michigan doctor pleaded guilty to conspiracy to commit healthcare fraud. As part of his plea agreement, he admitted that he conspired with the 37-year-old owner of the pain clinics to carry out the Medicare fraud scam. He also revealed that the pain clinic owner and others directed multiple physicians to write prescriptions and deliver the injections for the unneeded services. Today’s fraudster, along with others, also referred Medicare beneficiaries to designated third-party home health agencies, labs and other diagnostic providers so they could also benefit from the ruse. His sentencing is scheduled.

The pain clinic owner and five others were charged in the $19 million Medicare fraud scheme that involved three Detroit-area providers. Obviously, those charged are innocent until proven guilty. (It’s quite possible that they are about to get a diagnosis that they won’t like and a prescription that won’t make them feel any better.)

Source: Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Doctor Pleads Guilty to Health Care Fraud Conspiracy for Role in $19 Million Detroit Area Medicare Fraud Scheme,” released on October 3, 2017.

A physician pleaded guilty today to conspiracy to commit health care fraud for his role in an approximately $19 million Medicare fraud scheme involving three Detroit area providers.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Daniel L. Lemisch of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Division, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office and Special Agent in Charge Manny Muriel of Internal Revenue Service Criminal Investigation (IRS-CI) made the announcement.

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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.