Psyching Out Fraud

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In modern terms, the phrase ”psyched out” can refer to ”being excited” about something. (Someone could be ”psyched out” about an upcoming vacation to the Bahamas.) The term ”psyched out” can also mean ”to be intimidated.” (A sports team could be ”psyched out” because their opponent has all wins and no losses.) Today’s ”Fraud of the Day” from the Glendale News-Press describes a California resident who tried to get away with ”psyching out” Medicare through a prescription harvesting scheme that involved billing the government benefits program for anti-psychotic medicine.

The story reports that a California woman, who holds an Armenian medical license, bilked Medicare of more than $20 million through an elaborate health care fraud scheme linked to a medical imaging clinic.

She used the name and license number of a local doctor’s name (with his permission) to write phony prescriptions for homeless patients she saw at the clinic.

The scheme involved ”prescription harvesting” by local pharmacies that allegedly re-billed both Medicare and Medi-Cal, the state health benefits program, for expensive anti-psychotic medications. According to the article, the clinic wrote the prescriptions for the unnecessary drugs, local participating pharmacies filled the prescriptions and then the clinic funneled the prescription drugs back to the participating pharmacies and black-market wholesalers. The drugs were relabeled, repackaged and re-dispensed.

Veterans, low-income senior citizens, and Medicare and Medi-Cal beneficiaries were recruited and their personal information was used to bill the government for services and prescriptions they did not need. Stolen identities were also used to write thousands of additional prescriptions. During a three-week trial, evidence showed how patient files were altered to show that the patients needed the prescribed treatment.

The 49-year-old woman and the 47-year-old doctor, who consented to having his name and license number used to write the prescriptions, were both found guilty. Along with another co-conspirator, the three all face a mandatory two-year sentence for identity theft. The woman and the doctor also face a maximum sentence of 30 years in federal prison.

These fraudsters preyed upon the less fortunate and used them as collateral to line their pockets with millions of dollars of which they were not entitled. The victims were most likely not mentally ill in this case, but facing a possible 30 years in prison may require a sedative of some sort for the two main criminals in this case. (I’m pretty sure they are not ”psyched out” about their upcoming sentencing nor the prospect of spending a considerable amount of time behind bars.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Glendale Resident Found Guilty in Healthcare Fraud Plot,” written by Veronica Rocha and published by the Glendale News-Press on February 18, 2014.

A 49-year-old local woman was found guilty Tuesday for her role in an elaborate $20-million healthcare fraud scheme that officials say involved a medical imaging clinic in south Glendale.

Nurista Grigoryan, a Glendale resident, allegedly fraudulently used an American doctor’s name and license number when she saw homeless patients at Manor Medical Imaging Clinic in the 200 block of North Central Avenue, according to a statement from the U.S. Attorney’s Office.

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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.