Feeding Fraud

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If a patient is unable to consume food or liquids by mouth, doctors may prescribe a feeding tube that can be put directly into the stomach through the abdomen. This procedure bypasses the mouth and esophagus and goes directly into the intestinal system, allowing the person to get the necessary nutrition needed to sustain life. An article in The Rancher describes how the co-owner of a medical supply company billed Medicare for thousands of feeding tube supply kits, but never actually ordered or delivered them.

The story states that the 47-year old co-owner was also the director of operations and the chief compliance officer. (Apparently, she was responsible for keeping herself accountable, making the fraud that much easier to accomplish.) The fraudster committed her crime by using the Unique Physician Identification Numbers (UPIN) of several Houston-area doctors to submit approximately $1.48 million in claims to Medicare for 29,113 tube feeding kits that were never ordered or delivered to Medicare beneficiaries.

After a three-day trial, it only took two hours for the jury to reach a decision. The fraudster was convicted of 14 counts of health care fraud and seven counts of aggravated identity theft. She faces up to 140 years in prison for the health care fraud and a mandatory 14 years for aggravated identity theft.

Greed feeds fraud. This woman saw the opportunity to take advantage of her position to bilk the health care system of funds that were intended for deserving beneficiaries. (In this case, her eyes were bigger than her stomach, and she had too much on her plate, which got her busted.) One thing is for sure, her new standards of living in prison will not allow her gourmet food selections from the prison chow line.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Houston Woman Convicted of Health Care Fraud Following State, Federal Probe,” published by The Rancher on April 6, 2014.

Andrea Michelle Tellison, 47, has been convicted today of 14 counts of health care fraud and seven counts of aggravated identity theft, announced United States Attorney Kenneth Magidson. The jury returned its verdicts this afternoon following three days of trial and less than two hours of jury deliberation.

Tellison, the director of operations, chief compliance officer and co-owner of Texas Durable Medical Company was charged in March 2013 with health care fraud and aggravated identity theft in relation to the submission of approximately $1.48 million worth of enteral nutrition and enteral feeding supply claims to Medicare.

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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.