I’m Having a Fraud Attack

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Would you know what to do if someone exclaimed? ”I’m having a heart attack?’? My guess is that you are not a cardiologist, so your knowledge of treatment past calling 9-1-1 and providing CPR would probably be limited. According to a NorthJersey.com article, one cardiologist cashed in on wrong diagnoses.

The article reports that a cardiologist who ran medical services companies in New York and New Jersey found himself in a predicament for which even he couldn’t diagnose a solution. (And, that’s saying something.) An investigation found that the doctor ran a ”medical mill,” accounting for a $19 million fraud scam. (What was he ordering? Top of the line tests for a hiccup?) He pleaded guilty to one count of conspiracy to commit health care fraud and one count of Social Security fraud, related to a separate scheme of providing his wife with a ”no-show” job. (He has his hands a couple different practices – medicine and fraud.) In a plea deal, he agreed that he charged Medicare, Medicaid and other insurers for the total amount of $19 million in fraudulent billings between 2004 and 2010. The article noted this scam is the largest of its kind ever recovered in the tri-state area.

How exactly did a man of medicine have time to treat patients and commit such a large fraud? Easy – he found his solution and money in his patients’ problems. Officials explained that he regularly ordered the same battery of diagnostic tests for patients regardless of their reason for seeking medical attention. Also, he forced employees to perform unnecessary tests on patients and falsely diagnosed patients to prescribe specific treatments. (You think a heart problem is the most of your worries; come to find out you’ve been scammed while trying to take care of yourself. If that doesn’t cause the heart attack, I don’t know what will.) In a statement, the defendant protested? ”The patients are more important than anything else.” (Of course, they bring in your income, Dr. Fraud.) The investigation uncovered unlicensed health care providers the doctor worked closely with to file fraudulent bills. In addition, officials discovered a related crime, where the doctor employed his wife for a job – even though she did not show up for it or do the job at all. She filled out W-2 forms and claimed $1.2 million in earnings, making her eligible for $263,000 in Social Security benefits for which she was not entitled. The defendant faces 57 to 87 months in prison.

Maybe they will let him do some prison work release. He can diagnose prisoners with heart problems and other ailments. He might even be able to get them medically released from jail so they can start a new fraud scam. In his case it seems ”a true diagnosis a day keeps this doctor away.”

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Paterson Cardiologist Admits to $19M Health Care Fraud,” written by Peter J. Sampson and published by the NorthJersey.com on April 10, 2013.

A prominent cardiologist who ran medical services companies in New Jersey and New York pleaded guilty on Wednesday to orchestrating a massive fraud that subjected thousands of patients to unnecessary tests and procedures and resulted in $19 million in losses.

Dr. Jose Katz, 68, of Closter, confessed his crimes to U.S. District Judge Jose L. Linares during a hearing in federal court in Newark.

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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.