Wooed by Fraud

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When it comes to Medicare fraud, an illegal scheme usually begins with the need for qualified beneficiaries. There are a variety of methods for wooing Medicare beneficiaries to participate, and as a Department of Justice press release states, one Detroit doctor chose to prescribe controlled substances to carry out his part of a $7 million scam.

The press release states that the doctor agreed to refer Medicare beneficiaries to multiple home health care agencies in the Detroit area for medically unnecessary services. He signed medical documents, including home health care certifications and care plans that falsely certified Medicare beneficiaries to receive home health care services. (He was fully aware that the falsified documents would be used by his co-conspirators to support the false Medicare claims.) In exchange for his signature, the home health care agency owners paid him with cash and through other forms of kickbacks.

Court documents show that the doctor lured Medicare beneficiaries to his practice through patient recruiters, who were then paid in cash for their ”delivery” services. Once the patients were under his care, the doctor would bill Medicare for medically unnecessary controlled substance prescriptions, home health care and physician services. Bogus claims totaled more than $6 million and approximately $5.5 million in fraudulent claims were paid out as a result.

The 66-year-old doctor pleaded guilty to one count of conspiracy to commit health care fraud. He is awaiting sentencing for his part in the scam to bilk the government benefits program.

Everyone has a weak spot, and this doctor knew what would work for his scam. Most fraudsters also have multiple vulnerabilities that cause them to commit illegal acts. In this case, the doctor was wooed by the love of cold hard cash. Unfortunately for him, there is a good chance that selfishness and greed will land him behind bars.

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Physician Pleads Guilty for Role in Detroit-Area Medicare Fraud Scheme,” issued by the Department of Justice on July 1, 2014.

A Detroit-area physician pleaded guilty today for his role in a $7 million health care fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office made the announcement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.