Whether Needed or Not

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A lot of Medicare fraud occurs when claims for medical services allegedly rendered are submitted, regardless of whether the patient needed it or not. Unscrupulous providers who submit these fraudulent claims are counting on their elderly patients to not look too closely at their billing statements. (They are also hoping that Medicare is too busy to examine the bogus claims.) A Texas doctor, who is one of six doctors implicated in quite possibly the largest Medicare fraud bust in Medicare Fraud Strike Force history, was recently found guilty for his involvement in a scam that stole more than $40 million from the government benefits program.

The doctor, who worked at a Dallas-based home health care company for four-and-a-half years, served as the company’s medical director. While employed, his Medicare number was used by the company to bill the government health care program. An investigation by the Medicare Strike Force found that more than 97 percent of the company’s Medicare patients received home health care regardless of whether they needed it or not.

The doctor and his cohorts submitted false certifications to Medicare claiming that he provided medical services when in reality, another doctor did. (This was so that the company could bill for a higher reimbursement rate.) In addition, he claimed that he performed comprehensive and lengthy patient exams when he did not. The fraudulent physician also signed forms claiming that the Medicare beneficiaries qualified to receive home health services, when they were actually ineligible for the benefits. (Sometimes the doctor didn’t even have knowledge about the patient or their medical condition, yet submitted a bogus claim anyway.)

The 56-year-old doctor pleaded guilty to conspiracy to commit health care fraud. He currently faces a fine of up to $250,000 or twice the gain or the loss to his victims and up to 10 years in federal prison. Four other doctors employed by the same company have also pleaded guilty to their role in the scam and one other has an upcoming trial date.

Congratulations to the Medicare Fraud Strike Force for stopping this Medicare scam which ultimately involved 243 people. (Many were physicians, nurses and other licensed medical professionals.) In today’s ”Fraud of the Day,” there is no question as to whether or not this fraudster needs to be punished for his involvement in the scam. Let’s hope that the final sentence will send a message to other ”would-be” fraudsters that using a taxpayer funded program to pocket some extra cash is not allowed.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Waxahachie doctor, five others responsible for $40 million Medicare fraud,” published by Daily Light on December 11, 2016.

DALLAS – As part of the largest Medicare fraud bust made in the short history of the Medicare Fraud Strike Force, the case against a former Waxahachie doctor, along with five others, is nearing a close. The final investigation found more than $40 million in fraudulent Medicare claims.

According to U.S. Attorney John Parker of the Northern District of Texas, three of the six former doctors, all from North Texas, have entered guilty pleas over the last three weeks – the latest being Myrna S. Parcon, 63, of Dallas. Parcon pleaded guilty Nov. 29 to one count of conspiracy to commit health care fraud and faces up to 10 years in a federal prison and a fine up to $250,000 or twice her monetary gain or the loss to the victim.

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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.