Keeping Stories Straight

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When multiple people are involved in fraud, it is important to keep stories straight so suspicions are not raised. An article published by Alaska Dispatch News details what happened when a doctor and his office manager did not tell the same story about their alleged involvement in a $1.2 million Medicaid fraud scheme.

The article states that an Alaskan doctor, who primarily treated children for mental health issues, and his office manager supposedly billed Medicaid for approximately $1.2 million in fraudulent claims. Fortunately, Medicaid did not pay all of the bills.

During a 45-minute conversation, the office manager reportedly was able to capture the doctor admitting to the scheme and emphasizing the importance of telling the same story so that they might ”get past” the inquiry into the alleged fraud. (If true, this is troubling.) The story also mentions that the office manager and an ex-girlfriend testified that the doctor had a tendency to use prescription pills while working and often wrote multiple opiate prescriptions for friends. (Again, if true, that’s an abuse of position.)

The Anchorage doctor pleaded guilty to two felonies, including medical assistance fraud and evidence tampering. He also agreed to a plea deal and will serve time between one to three-and-a-half years in prison. He will be required to complete 10 years of probation, but can apply for early termination after five years if all restitution is paid in full.

The article does not say what happened to the office manager who originally assisted with the fraudulent billings, but it’s safe to assume that his efforts greatly reduced any punishment he would have received if he had continued to cover up the fraud. It just goes to show that the best story anyone can tell is the truthful one. Lying always leads to a bad ending.

Source: Today’s ”Fraud of the Day” is based on an article titled ”Anchorage Physician Pleads Guilty to Medicaid Fraud,” written by Jerzy Shedlock and published by Alaska Dispatch News on December 1, 2014.

Dr. Shubhranjan Ghosh, an Anchorage physician charged with Medicaid fraud totaling more than $1 million, pleaded guilty Monday to two charges as part of a plea agreement.

Ghosh entered guilty pleas for single counts of medical assistance fraud and evidence tampering, both felonies, according to the state’s plea agreement.

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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.