Smoke Screen

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Counselor’s Medicaid Fraud Sentencing Cancelled,” published by The Argus Leader on April 29, 2015.

A man who’d once admitted to Medicaid fraud will take his case to trial after a judge rejected his plea agreement at sentencing.

Shawl Nills, 41, was set to be sentenced Wednesday in Madison for making false claims to Medicaid, but Judge Vince Foley decided not to proceed.

Losing Control

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article entitled “Owner of N.J. Healthcare Agency Admits to $7 Million Fraud, Bribery, and Tax Evasion” posted on NJ.com on April 20, 2015.

NEWARK — The owner of a Linden home health care agency pleaded guilty to carrying out a multimillion dollar Medicaid fraud, bribery and other offenses that could lead to decades in prison, the office of U.S. Attorney for New Jersey Paul Fishman announced Monday.

Irina Krutoyarsky, 61, of Springfield, owner of HHCH Health Care, is scheduled to be sentenced in September after admitting she told the state’s Board of Nursing that the aides she employed had completed required training and testing when in reality she charged the aides hundreds each for obtaining fraudulent credentials.

The Sobering Effect of Fraud

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Brookline Doctor Sentenced to Jail, Fined for Medicaid Fraud,” written by Jack Newsham and published by The Boston Globe on April 7, 2015.

A Brookline doctor has been sentenced to 11 months in jail and ordered to pay $9.3 million for running a Medicaid fraud scheme.

Dr. Punyamurtula Kishore and his statewide chain, Preventive Medical Associates, Inc., were found guilty of fraudulently billing MassHealth for unnecessary drug tests. According to the state, Kishore collected urine samples from drug treatment centers across the state and billed the Medicaid provider for testing them, even though the people who provided the samples weren’t being treated by his clinics and the tests weren’t medically necessary.

What Goes On Behind Closed Doors

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Former NSU Vice Rector Sentenced for $1.4 Million Fraud,” written by Scott Daugherty and published by The Virginian-Pilot on January 9, 2015.

Prosecutors wanted W. Wayne Perry Jr. to serve more than 21 years in federal prison.

Last year a jury convicted the former owner of a Norfolk-based home health care company and his wife of perpetrating a $1.4 million Medicaid fraud. Federal guidelines recommended a lengthy sentence, and Assistant U.S. Attorney Melissa O’Boyle argued Perry deserved every day. She blasted the former vice rector of Norfolk State University for showing no remorse and blaming others for his wrongdoing.

Keeping Stories Straight

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled “Anchorage Physician Pleads Guilty to Medicaid Fraud,” written by Jerzy Shedlock and published by Alaska Dispatch News on December 1, 2014.

Dr. Shubhranjan Ghosh, an Anchorage physician charged with Medicaid fraud totaling more than $1 million, pleaded guilty Monday to two charges as part of a plea agreement.

Ghosh entered guilty pleas for single counts of medical assistance fraud and evidence tampering, both felonies, according to the state’s plea agreement.

Home Alone

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Man Commits Medicaid Fraud from Illinois Jail, Court Says,” written by Blythe Bernhard and published by the St. Louis Post-Dispatch on September 5, 2014.

A man submitted claims for working in an Illinois health care program while he was incarcerated in an Illinois jail, federal prosecutors announced today.

U.S. Attorney Stephen Wigginton of the Southern District of Illinois said Christopher Spivey, 30, pleaded guilty to submitting bills to the state Medicaid agency for caring for a patient in a program aimed at keeping people in their own homes instead of nursing facilities. Spivey was incarcerated at the Richland County Jail in Olney, Ill. at the time he claimed to be taking care of the patient. A sentencing date was not announced.

Crossing the Line

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “11 Charged in Medicare/Medicaid Fraud Scheme,” posted on NBCMiami.com on November 19, 2014.

Federal agents raided Florida Healthcare Plus in Coral Gables Wednesday for allegedly running a more than $25 million Medicare, Medicaid, and wire fraud scheme.

Authorities said eleven people were involved in the schemed to defraud the government. According to the federal indictment, Florida Healthcare Plus (FHCP) was authorized by Medicare and Medicaid to offer plans to the beneficiaries, which was then allegedly taken advantage of by the defendants.

Abusing Trust

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Pair Allegedly Took Advantage of Cobb Children for Medicaid Fraud,” written by Justin Ove and published by The Ackworth Patch on November 11, 2014.

A grand jury in Cobb County has charged two people with Medicaid fraud, identity fraud, and conspiracy to defraud the state for a scheme which allegedly stole the Medicaid numbers of local children and used them to receive hundreds of thousands of dollars of bogus billing payments from the state.

Matthew David Harrell owned Revive Athletics, Inc. in Henry County, and Andrea Lillie Barrett was the owner of Lillie Cares Health Services, LLC in Glynn and Chatham counties. Both defendants’ companies were enrolled as service providers for Georgians on Medicaid.

Falling on Hard Times

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Father, Son Sentenced in Medicaid Fraud Case,” written by Karen Blackledge and published in The Daily Item on October 7, 2014.

DANVILLE — An elderly father was placed in a special program to expunge a charge of Medicaid fraud while his son will spend at least two months in jail.

Montour County Judge Gary Norton allowed David L. Albertson, 75, of 24 Montour St., to participate in the Accelerated Rehabilitative Disposition Program for one year where successful participation will result in the elimination of charges.

Can’t You Hear the Whistle Blow

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Organon to Pay $31 Million Over FCA Medicaid Allegations,” written by Erica Teichert and posted on Law360.com on October 15, 2014.

Drug manufacturer Organon USA Inc. has agreed to pay $31 million to settle allegations from the federal government and several states, including New York and Kentucky, that it underpaid rebates to state Medicaid programs, several state attorneys general said Wednesday.

Organon faced two separate lawsuits in Texas and Massachusetts federal court, claiming the company underpaid Medicaid rebates, offered improper financial incentives to nursing home pharmacy companies, misrepresented drug prices and promoted drugs for off-label uses, according to the state attorneys general.

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