Rolling Away with Fraud

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The durable medical equipment industry is rife with power wheelchair fraud. In fact, the Centers for Medicare and Medicaid Services have seen an increase of nearly 450 percent in spending over the past four years. (All of that cannot possibly be legit.) Today’s “Fraud of the Day” covers the illegal actions of an office manager at a Texas-based medical supply company that illegally billed Medicaid and Medicare for power wheelchairs that were not necessary.

Two other people were involved in the scam, including the owner of the medical supply company and another woman, who was hired to recruit customers. (The recruiter was paid on commission to obtain customers in the Waco area.) Over more than three-and-a half years, the office manager worked closely with the recruiter to collect customer information, generate fake claims for power wheelchairs, and submit them to the government for reimbursement.

The office manager used the names of doctors to support the claims; however, these physicians never prescribed the power wheelchairs and in some cases, did not know the patient. Even though the company billed the two healthcare agencies for power wheelchairs, they delivered less-expensive powered scooters instead. (This enabled the company to collect a larger payment from Medicaid or Medicare and reward the owner with a higher profit.)

The medical supply company owner, a 55-year-old man, was convicted of one count of conspiracy to commit healthcare fraud, one count of aiding and abetting healthcare fraud, 11 counts of aiding and abetting aggravated identity theft and eight counts of aiding and abetting false statements related to a healthcare matter. He was sentenced to 27 years in federal prison and ordered to pay more than $3.2 million in restitution. He’ll also spend three years on supervised release following the completion of his prison term.

The 46-year-old office manager was convicted on the same charges as the owner and received a sentence of 17 years in prison, plus three years on supervised release. Her restitution amount is $3.3 million. The 60-year-old recruiter pleaded guilty to a conspiracy charge. She will serve 87 months in federal prison. (To put it in perspective, the three will spend a collective half century in jail.)

While many durable medical equipment companies are ethical and provide wheelchairs to beneficiaries that truly need them, there are many unscrupulous suppliers that provide free wheelchairs to those who do not need them and leave the government with the bill. Fortunately, the government is successfully striking back at these criminals with laws that enable more aggressive scrutiny. The amount of similar cases has decreased because physicians must now actually see and perform an exam before prescribing a power wheelchair. (While these three criminals thought they’d be allowed to roll away with fraud, their scam has definitely come to a grinding halt.)

Source: Today’s “Fraud of the Day” is based on an article entitled, Woman sentenced in $3.5M Central Texas health care fraud schemeposted on KWTX.com on June 14, 2017.

DEL RIO, Texas (KWTX) Kathleen Kelly-Tuorila, 46, who was convicted almost a year ago in what authorities described as a $3.5 million Central Texas health care fraud scheme, was sentenced to 17 years in prison, three years on supervised released and ordered to pay about $3.3 million in restitution late Tuesday afternoon in U.S. District Court in Del Rio.

DTS Medical Supply owner Daniel Thomason Smith, 55, and Kelly-Tuorila, who was the firm’s officer manager, were convicted on June 28, 2016 of one count of conspiracy to commit health care fraud, one count of aiding and abetting health care fraud, 11 counts of aiding and abetting aggravated identity theft and eight counts of aiding and abetting false statements related to a health care matter.

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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.