Unhappily Ever After

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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.

MIAMI (CBSMiami/AP) — A South Florida man pleaded guilty in a $205 million Medicare fraud scheme.

Former Network Resource Consultant Inc. chief Michael Mendoza pleaded guilty to health fraud conspiracy Thursday, June 19th in Miami federal court.

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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.