Putting the Brakes on Fraud

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43132131 - office desk a stack of computer paper reports work forms.

There are a variety of ways to commit Medicare fraud including billing for unnecessary services or services not provided, up-coding or double-billing, or offering or accepting kickbacks, just to name a few. Today ‘s fraudsters, who were man and wife, tried a different tactic and filed incorrect mileage claims with Medicare through their laboratory, resulting in a loss of more than $160,000 to the government health care benefits program.

The couple, who owned a clinical diagnostic lab, provided services to nursing homes throughout East Texas. (They were responsible for inflating mileage amounts incurred by phlebotomists who visited the facilities to draw blood from patients.) The lab owners conspired to inflate the number of miles used to calculate the travel allowances billed to Medicare. (According to documents presented to the court, they collected approximately $8 million in excess of what they should have received.)

A former employee blew the whistle on the man and woman, alleging the couple submitted false claims to Medicare over four years through their company. The man and his wife ended up pleading guilty to conspiring to commit health care fraud.

The 61-year-old husband was sentenced to two years in federal prison, while the 52-year-old wife received five years of probation. They were both ordered to pay $161,695 in restitution. The couple and the lab also agreed to pay the government $3.75 million to settle the lawsuit. (Sounds fair enough.)

Just to make sure that these two don’t drive any further down the highway of fraud, the lab, the man, and the woman are all excluded from participating in the Medicare program for eight, 10, and eight years respectively. (Let ‘s hope this puts the brakes on their fraudulent activity for good.)

Source: Today’s “Fraud of the Day” is based on an article entitled, “Tyler couple sentenced in Medicare fraud case,” published by the Longview News-Journal on May 4, 2017.

A Tyler couple has been sentenced for health care fraud violations in the Eastern District of Texas, acting U.S. Attorney Brit Featherston announced Thursday.

Gerard Dengler, 61, and Suzanne Dengler 52, pleaded guilty Jan. 10.

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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.