Down in New Orleans

Closeup rear low angle view of an early 60's senior gentleman having some back pain. He's at doctor's office having medical examination by a male doctor. The patient is pointing to his lumbar region.

Workers’ Compensation Programs provide wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits to individuals who have experienced work-related injuries or illnesses. (Where there’s a benefit program to be scammed, you can be sure there are fraudsters waiting in line to do so.) 

That is the case with a doctor from Baton Rouge, La., who has been sentenced to a year-and-a-half in prison for his role in a workers’ compensation fraud scheme. Marvin Clifton was found guilty of submitting over $500,000 in false claims to the Louisiana Office of Workers’ Compensation Program.  

Clifton owned and operated a medical practice that specialized in physical therapy in Baton Rouge. From January 2015 to January 2019, Clifton sought to exploit patients that were receiving medical benefits through the state’s Workers’ Compensation Program. Maybe if he’d spent those years trying to grow his business instead of committing fraud, he wouldn’t be in this situation.)

Using his company, Clifton willingly tried to defraud the Louisiana Workers’ Comp Program by falsifying and concealing material facts, as well as taking advantage of vulnerable patients who were receiving benefits. (These patients put their trust in him. And, he took advantage of them to the fullest extent possible.)  

Office managers at Clifton’s medical practice stated that they were instructed to bill for treatment on days the office was closed. (Needless to say, this isn’t a business practice anyone should emulate.) They were also told to bill for longer treatment sessions than were needed or were provided to the patient. Additionally, Clifton billed Workers’ Compensation patients for physical therapy and other medical treatments that he never provided. (Fraudsters always make the mistake of assuming their victims are dumb and they won’t catch on when they’re being billed for services they didn’t receive.)  

Over $500,000 in fraudulent billings were submitted to Louisiana’s Workers’ Compensation Program throughout the course of Clifton’s scheme. Clifton received about $340,342.58 in reimbursements from the U.S. Department of Labor for services never rendered.

In addition to being sentenced to a year-and-a-half in prison, Clifton was sentenced to two years of supervised release. (Seems like a light sentence for someone who stole hundreds of thousands of dollars.)  He was also ordered to pay a $50,000 fine and a $100 special assessment.

If you suspect someone of committing Workers’ Compensation Fraud you can report it to the Office of Inspector General’s online complaint form.

Today’s Fraud of the Day comes from an article, “Louisiana Doctor Sentenced to Prison in $500K Workers’ Comp Fraud Case,” published by Insurance Journal on March 13, 2020.

A Baton Rouge, Louisiana, doctor has been sentenced to 18 months in federal prison after being convicted of participating in a workers’ compensation fraud scheme in which he submitted more than $500,000 in false claims, according to the U.S. Attorney’s Office for the Middle District of Louisiana.

Marvin Clifton, M.D., age 71, whose medical practice included physical therapy, also was sentenced to two years of supervised release following his imprisonment, and to pay a $50,000 fine and a $100 special assessment.




Previous articleCOVID Feature: Nowhere to Fly Away To
Next articleAiding and Abetting
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.