Shame on Me

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WZZM13, a Michigan ABC affiliate, recently reported on a $1 million healthcare scam involving a physician’s assistant, who was caught not only receiving illegal referral kickbacks, but also prescribing drugs to his own romantic partners, to patients with whom he shared the drugs and to those he knew were reselling the drugs on the black market.

When investigators raided the physical office to which this physician’s assistant had referred at least five patients in exchange for illegal kickbacks, he refused to let that break his depraved, double-dealing spirit. Instead, he simply picked up where he had left off, with a different prescriber. (Despite his relatively inferior status within a much larger crime ring, there’s a reason this particular man is at the center of the story: He really does sound quite cheeky.)

Ultimately, federal investigators caught up with him, as they unraveled a plot that landed seven other doctors and physicians assistants in federal prison. When all was said and done, this poisonous P.A. was found to have billed federal programs for more than 30 pneumonia vaccines that were never provided and collected $1,000 in hidden kickbacks related to $18,000 in services paid out by Medicare and Medicaid. Not to mention the prescription drug dealing and abuse he facilitated among his wide-reaching social circles.

So the Attorney General dragged him to court, where he (perhaps, unsurprisingly) revealed a brazen disregard for the gravity of his crimes, in a particularly glib letter to the presiding judge. An excerpt reads, “Shame on me for being naïve, trying to work three jobs and not paying attention. In the future I promise to make the right and ethical decisions by learning from this.” Unimpressed, the judge sentenced him to fourteen months in prison, followed by two years of supervised release. Additionally, he was ordered to pay $18,000 in restitution.This man’s individual crimes negatively affected many lives, including his own, as did his role in a larger scheme that put patients’ well-being directly at odds with their health care providers’ financial bottom line.

Source: Today’s ”Fraud of the Day” is based on ”Medical kickback scam brings health worker prison,” written by John Hogan and WZZM13 staff and published by WZZM13 on January 11, 2016.

GRAND RAPIDS, Mich. (WZZM) — A physician’s assistant who collected illegal kickbacks for referring patients to physical therapy was sentenced Monday to 14 months in federal prison and ordered to pay the government $18,000 in restitution.

Kyle D. Gandy, 37, was indicted in May for accepting kickbacks after referring five patients to medical offices run by Babubhai Rathod, including Lakeshore Spine & Pain in Ludington. The kickbacks were disguised as mileage reimbursement and contract work, court records show.

Federal prosecutors say he also billed federal programs for 34 pneumonia vaccines that he didn’t provide and wrote prescriptions for romantic partners.

Gandy was a cog in a $1 million health care scam that brought convictions for several people linked to Rathod. The Okemos man in Aug. 2013 was sentenced to four years in prison and ordered to pay $950,000 restitution for the statewide kickback scheme.

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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.