Footing the Fraud Bill

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Podiatrists have a complicated and sometimes unpleasant job when it comes to the diagnosis and treatment of more than 26 bones, over 100 muscles, tendons and ligaments and 33 joints in the foot. A podiatrist in Pennsylvania used his patients to take a load off of his own feet. By fraudulently billing the government and private insurance companies for work he did not perform, his practice collected $5 million in undeserved payments.

An article published in the Delaware County Daily Times states that for seven years, the fraudster submitted bogus claims to Medicare, Medicaid and four private insurance companies for procedures that were not provided or performed and billed for medically unnecessary procedures and services. (Why work when you can get free money?)

Great work by the Medicare Strike Force who held this doctor’s feet to the fire. The 59-year-old podiatrist is facing up to 10 years in prison, as well as $5 million in restitution, fines and criminal forfeiture. As part of a plea deal, he will be required to surrender his medical license.

Federal officials noted that this case was also part of a greater overall scheme that involved 301 individuals including doctors, nurses and other licensed medical professionals within 36 federal districts. It is estimated that the total loss to the government health care programs and the private insurance companies was approximately $900 million.

So who foots the fraud bill in cases like this? Honest taxpayers do. Because the government doesn’t take kindly to being swindled, I’m guessing that when the judge is done sentencing this fraudster for his crimes, he won’t have a foot to stand on.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Broomall podiatrist admits role in $5M insurance scam,” published by the Delaware County Daily Times on August 28, 2016.

PHILADELPHIA – A Broomall podiatrist pleaded guilty Thursday to defrauding Medicare, Medicaid and four private victim insurance companies out of approximately $5 million, according to a release from U.S. Attorney Zane David Memeger.

Stephen A. Monaco, 59, of Marple, was charged in June as part of what federal officials said was the largest national Medicare fraud takedown in history.

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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.