Working the System

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Because chiropractors typically emphasize ongoing treatment for neuromusculoskeletal disorders, there are concerns in the workers’ compensation field that patients may not be discharged if long-term relief is not achieved. In some state workers’ compensation systems, chiropractic treatment parameters are often limited because of this. The Ohio Bureau of Workers’ Compensation (BWC) recently limited a chiropractor’s ability to treat patients due to his fraudulent billing practices.

Today’s “Fraud of the Day” focuses on a Cleveland chiropractor who submitted fraudulent bills for services he never provided to injured workers within the BWC system. The BWC’s Special Investigations Department went undercover to interview injured workers and conduct surveillance in the man’s clinic. (After a search warrant was executed, investigators found that the chiropractor had falsified patient treatment notes and billed for services he did not perform because he was out of the country.)

The 44-year-old man agreed to stop treating the injured workers in the BWC system after pleading guilty to a misdemeanor charge of workers’ compensation fraud. (That’s probably a better choice than letting it go to trial where the punishment could be worse than the one he received.)

The judge ordered him to reimburse the BWC $10,862 for services he billed for, but never provided. He also had to pay $46,534 for the cost of the agency’s investigation into his fraudulent billing practices. (Investigators found another $8,784 in checks received for services that were not provided. Luckily the checks had not been cashed yet.)

While chiropractors legitimately provide services to many injured workers that allow for their recovery, this particular chiropractor obviously worked the system so he could line his pockets with extra cash. Great work BWC for stopping this fraudster.

 

Source: Today’s “Fraud of the Day” is based on an article entitled, “Cleveland chiropractor convicted of workers’ comp fraud” posted on ohiobwcfraud.wordpress.com on March 3, 2017.

A Cleveland chiropractor refunded the Ohio Bureau of Workers’ Compensation more than $57,000 on Feb. 15 and agreed to stop treating injured workers in the BWC system after pleading guilty to workers’ compensation fraud in a Franklin County courtroom.

Following a judge’s orders, Michael C. Wilson, 44, reimbursed BWC $10,862 he received for services he never rendered to injured workers. He also paid BWC $46,534 for the cost of the agency’s investigation into his fraudulent practices, which included falsifying treatment notes and billing for services he couldn’t have performed because he was out of the country.

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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.