Bogus Bonuses

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hand holding American dollar currency isolated on blurred blackground injured woman with broken hand and green cast on arm, insurance health concept.

Workplace performance bonuses are a great thing, unless they are driven by incentives that can send you to jail. That is the case for a pair of Texas women who were convicted recently on six counts of healthcare fraud that involved overbilling the federal workers’ compensation program out of $5.5 million.

The two women – a 48-year-old from Lorena and a 42-year-old from Grand Prairie – worked in the billing office for Dr. Les Benson, an emergency medicine physician in Waco and former pro football player with the Dallas Cowboys in the 1970s. (Now there’s a convenient connection to people at risk of injuries.)

Benson was indicted on related fraud charges and his medical license was suspended in 2018. (Although he was not mentioned in court documents involving the billing clerks.)

Criminal complaints stated that “Physician A” incentivized the billing clerks to maximize billing by offering a bonus if their respective clinics billed more than $50,000 per week. (That’s an odd business model for a practitioner who supposedly cares about his patients.) The billing clerks submitted and/or taught others to submit false healthcare claims between January 2011 and March 2017.

A federal jury convicted the Lorena woman after a five-day trial. The Grand Prairie woman pleaded guilty to healthcare fraud and is scheduled to be sentenced in March for billing the Department of Labor’s Office of Workers Compensation for more physical therapy work than was performed.

Today’s Fraud of the Day comes from the news report, “Texas Woman Convicted in $5.5 Million Health Care Fraud Scheme, DOJ Says,” published Dec. 14, 2019.

Texas woman was convicted Friday on six counts of health care fraud in connection with a $5.5 million federal workers’ compensation overbilling scheme, U.S. Justice Department officials said.

Melissa Sumerour, 48, of Lorena, was found guilty by a federal jury following a five-day trial, DOJ officials said in a statement.

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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.