Not Quite Right

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If a doctor’s practice, home health care company or medical supply company has to pay a recruiter to bring in patients, then you can be sure that something is not quite right. (You can almost bet that Medicare or Medicaid fraud is going on.) An article posted on KWTX.com tells about a Texas-based medical supply company owner who used a patient recruiter to grow his fraudulent business model. Over nearly four years, he used his ”new” patients to steal $3.5 million from the two government benefit programs.

Fraudulent patient recruiters frequently drum up new customers by soliciting the homeless, drug and alcohol rehab program patients, the elderly and the mentally disabled. (Or, anyone who is qualified to receive benefits from Medicare or Medicaid.) Many of the recruited patients do not need any treatment, but because they are qualified beneficiaries, recruiters often lure them by providing a variety of free offers.

The medical supply company owner and his office manager hired a patient recruiter to help carry out their fraudulent scheme, which involved generating and submitting bogus claims for power wheelchairs. The story states that the office manager used the names of doctors (unbeknownst to them)and the newly recruited patients to request reimbursement for power wheelchairs that were not medically necessary. (The physicians never prescribed the wheelchairs and either didn’t know the patients or never had them as a patient.) The medical supply company also delivered less-expensive wheelchairs to patients, but billed as if they were powered, which resulted in a higher profit margin for the firm.

A jury found the 55-year-old company owner and his 45-year-old office manager both guilty on a total of 21 counts including conspiracy to commit health care fraud and aiding and abetting health care fraud, identity theft and false statements related to a health care matter. They are each looking at a maximum of 82 years in prison for their fraudulent acts. The patient recruiter pleaded guilty to the conspiracy charge and is also awaiting sentencing.

Fraudsters tend to prey upon those who are the most vulnerable, like the victims in this particular case. Government investigators realized that something was not quite right and they stopped these criminals from rolling away with benefits they did not deserve.

Source: Today’s ”Fraud of the Day” is based on an article, ”Federal jury convicts Killeen man, woman of health care fraud,” published by KWTX on June 29, 2016.

KILLEEN, Texas (KWTX) A Killeen medical supply company owner and the company’s office manager were found guilty in a Waco federal court Tuesday in connection with a $3.5 million health care fraud scheme.

The jury in visiting U.S. District Judge Alia Moses’ court found DTS Medical Supply Company owner Daniel Thomason Smith, 55, and office manager Kathleen Marina Kelly-Tuorila, 45, guilty of initiating a health care fraud scheme that netted the pair more than $3.5 million over almost four years.

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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.