Unhappily Ever After

Everyone likes a good fairytale. There’s always a tragedy of some sort and a struggle between good and evil. Just when it looks like the bad guy might prevail, a hero or heroine overcomes the injustice done to them and the evildoer gets banished from the kingdom while everyone else lives happily ever after. Today’s ”Fraud of the Day” from the CBS Miami affiliate follows the story of an evil fraud empire ruled by the greedy owner of the nation’s largest chain of community mental health centers licensed by Medicare. One of the pawns involved in the owner’s fraudulent scheme was a patient recruiter who helped the mental health center owner to bilk Medicare of more than $205 million.

The story states that the patient recruiter provided bona fide Medicare beneficiaries to the mental health clinics in exchange for kickbacks. (As you can imagine, the plot in this Medicare fraud story was the same as many others. The mental health treatments prescribed to the referred patients were either unnecessary or not provided.) Through his efforts, the patient recruiter enabled more than $430,000 in false Medicare claims to be submitted. The man pleaded guilty to his part in the scam.

Further research revealed that the company owner and his wife, who happened to be a mental health counselor, often held ”charting” parties where they falsified patient records to make it look like mental health therapy was needed. Of course, they didn’t act alone and required the assistance of many employees plus psychiatrists, counselors, nurses, marketers and patient recruiters to make the scam work. (Luckily, while more than $205 million in claims were submitted, only $87.5 million was paid out.) In another bold move, the owner actually set up an organization to lobby Congress to allocate more money to his company and co-conspirators. (Note to self: If you are scamming the government, you probably don’t want to set up an organization that has the sole purpose of keeping the government gravy train running.)

The mental health company owner got 50 years in the slammer for spearheading the scam, while his wife received a sentence of 35 years in prison. These lengthy sentences don’t bode well for the future sentencing others allegedly involved in the scheme. These criminals are going to be banished to the dark and egregious land of prison where they will most certainly not live happily ever after.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Patient Recruiter Guilty In $205M Medicare Fraud,” published by the CBS affiliate in Miami on June 20, 2014.

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