License to Defraud

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A medical license is a pretty important piece of paper that allows a physician to legally practice medicine. According to an article in Insurance Journal, the owner of a Houston health clinic used foreign medical students without medical licenses to treat injured patients and submit approximately $166,843 in fraudulent Worker’s Compensation claims.

The story explains that after the clinic’s doctor left the practice, the owner continued to use the doctor’s information to dispense prescriptions and began hiring foreign medical students to serve as medical license bearing doctors. The owner allowed the unlicensed medical students to treat injured patients, then submitted the fraudulent worker’s compensation claims so she could collect from multiple insurers.

The woman’s crime was revealed after the doctor who had departed the practice contacted the Texas Department of Insurance Division of Worker’s Compensation and explained to a case worker that he no longer worked for the clinic and had not written prescriptions after leaving the company.

An investigation ensued and the clinic owner and operator ended up pleading guilty to insurance fraud and practicing without a license. She was sentenced to seven years deferred adjudication and must pay $88,000 in restitution.

What is particularly scary about this case is that the clinic owner continued to accept patients despite the fact that there were no licensed medical providers on staff. (She put 50 injured workers’ health at risk to line her pockets with money she did not deserve.)

And if that wasn’t enough, she was also using the credentials of previously employed doctors and physician assistants to supply narcotics to patients. (While the article does not state if the clinic owner has lost her license to operate the business, you can be sure that the justice department will not permit her to have another license to defraud.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Texas Health Clinic Owner Sentenced for Workers’ Comp, Insurance Fraud” published by Insurance Journal on October 17, 2016.

The owner of a Houston health clinic pled guilty to insurance fraud after billing for medical services – often provided to injured employees – despite having no licensed medical staff at the clinic, the Texas Department of Insurance reported.

Instead, investigators found that the clinic was using foreign medical students to provide care.

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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.