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23159967 - two medical people handshaking at office

There are many things to consider when choosing a business partner. Before entering into a business venture, it’s important to join forces with someone who has industry knowledge, understands your working and decision-making style, has similar values, goals and skills, and most importantly, is someone you trust. A Tennessee doctor got more than he bargained for when he entered a partnership with a registered nurse to run three urgent care medical clinics. When the doc handed over the reigns to the male nurse, he took advantage of the physician’s credentials and committed Medicaid fraud.

Some partners don’t like to be involved in the day-to-day aspect of a business but serve as the financial backer. According to today’s fraud article, in addition to providing the money for the venture, the physician also served as the medical director for the clinics. (This means the doc was used as a figurehead to satisfy healthcare regulations. He did not actually treat any patients or review their medical records.)

The doc and the registered nurse went into business to open three urgent care medical clinics located in East Tennessee – specifically in LaFollette, Clinton and Oak Ridge. The Tennessee doctor handed over the daily management responsibilities to the registered nurse who evidently felt he was given carte blanche. He used the physician’s credentials to provide unlicensed medical treatments.

The nurse was not a licensed nurse practitioner or medical doctor when he provided medical treatment to 1,200 patients at one of the clinics, but he was the Chief Executive Officer of the company. (Over two-and-a-half years, he used his position to bill Medicaid and TennCare for $94,270 in services using his business partner’s medical provider credentials.)

Although the registered nurse held a multistate license, he was not approved to provide medical treatment or authorize prescriptions. (His business partner had no idea that his identity and medical national provider identifier (NPI) number were being used illegally.)

The registered nurse from Tennessee struck a plea deal to plead guilty to Medicaid fraud for billing Medicaid and TennCare. (The two government healthcare programs pay for the medical care of vulnerable children, the disabled and the poor.) Additional research found that he pleaded guilty to two counts of healthcare fraud. Each count carries a punishment of up to 10 years in prison, supervised release of up to three years, a $250,000 fine and a $100 special assessment.

So, what’s the moral of the story here? (There are three.) When looking for a business partner, it’s imperative to choose someone you trust. Secondly, don’t give your partner carte blanche to do whatever they see fit. And finally, when seeking medical treatment, ask to see the provider’s credentials if you don’t see a diploma on the wall or medical license displayed prominently.

Today’s “Fraud of the Day” is based on an article entitled, Owner of 3 East Tennessee clinics catering to poor admits to unlicensed patient care,” published by Knox News on April 23, 2018.

A registered nurse who operated medical clinics catering to low-income patients secretly used a doctor’s credentials to bill government insurance programs for treatment he wasn’t licensed to provide and to fool pharmacies into filling prescriptions he wasn’t authorized to write, court records show.

Matthew Meyers has struck a deal to plead guilty Monday before Senior U.S. District Judge Thomas Phillips in U.S. District Court to health care fraud.

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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.