Feeling the Pain of Fraud

11

It ‘s very important to monitor a patient during and after surgery. From the time that patients are put under anesthesia and wake up post-surgery, they need to be monitored. A Georgia doctor, who was responsible for performing surgical monitoring services billed multiple federal insurance programs for medically unnecessary diagnostic tests and services he did not actually perform.

While the doctor was supposed to be monitoring the neurological health of his patients who were undergoing surgery, he allowed an unqualified medical assistant to do so instead. The medical assistant logged in to the hospital or surgical center system using his credentials, giving the appearance that the doctor was monitoring the patient, when he was not. At the end of each surgery, a report was provided and was used to bill patients and health insurance companies.

For more than five years, the doctor caused false claims to be submitted to Medicare, Georgia and Kentucky Medicaid programs, TRICARE and the Federal Employees Health Benefits Program. In addition to not providing surgical monitoring, the doctor also performed medically unnecessary balance tests, nerve conduction and electromyography procedures and drug screens. (Let ‘s see, what else can I bill the government for?)

The 55-year-old physician pleaded guilty to health care fraud and agreed to pay $20 million to resolve charges that he violated the False Claims Act. He is required to sell all but one of his residential and commercial properties, two boats, four jet skis and hand over the proceeds to the government. (Getting a picture of what he was doing while he should have been monitoring his patients?) Let ‘s hope the $20 million price tag on this fraud is painful enough to get this fraudster ‘s attention so that he will never put his patients or taxpayer dollars at risk again.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Doctor from Cumming to pay $20 million after health care fraud,” published by Forsyth County News on February 9, 2017.

A Forsyth County doctor who pleaded guilty to health care fraud in March and was sentenced in October has agreed to pay a $20 million consent judgment to resolve charges that he violated the False Claims Act.

On Thursday, Feb.2, Robert Windsor, 55, of Cumming, agreed to the deal, which will require him to sell all but one of his residential and commercial properties and give the net profits to the government.

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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.