License to Defraud

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63855042 - pharmacist showing medicine pills with pharmacy store shelves background

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, 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.