Multi-Agency Success

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Some problems are better solved in teams. For example, if you’ve seen some crime shows, you know that law enforcement agencies find teamwork a necessary method to crime solving. Combining multiple minds and perspectives, as well as different connections and processes, create the perfect recipe for cracking down on crime. Just think, if some of our favorite super heroes had teamed up, there would’ve been fewer cartoons – they would’ve solved crime and caught the ”bad-guys” much more efficiently. According to an article in the Times Picayune, combined government efforts created the perfect recipe for a health care fraud crack down in the south.

Things in Louisiana heated up when numerous federal and state agencies such as the Federal Bureau of Investigations (FBI), the federal Department of Health and Human Services (HHS), the Department of Justice (DOJ), the Internal Revenue Service (IRS) and state Department of Justice’s Medicaid Fraud Control Unit united to bring down one of the south’s largest healthcare scams. (And I thought the idea of super heroes joining forces was cataclysmic.) The various agencies combined to create a potent remedy for fraud, bringing a $21million scam to a halt, involving entities in both Louisiana and California. But how did such an elaborate scheme find $21 million in success without getting caught?

The investigations explained the workings of the scam? ”marketers” and ”recruiters” would find patients that they’d transport to clinics in exchange for cash and drugs. The scheme was directed by two Louisiana octogenarians who filed claims for procedures they either did not perform, or were unnecessary. The claims were filed by a company in California and the money was laundered back through a Louisiana company in the form of overpriced purchases of medical equipment and repairs. (They are taking this scam across state lines and back again.) An FBI Special-Agent-in-Charge, head of the agency’s New Orleans division stated? ”This case should serve as a reminder that the New Orleans-based health-care fraud law enforcement team will expand its reach well beyond the Louisiana borders, as necessary, to bring those individuals who defraud Medicare and Louisiana Medicaid to justice.’? The crackdown has sentenced numerous doctors and involved parties to jail time and restitution payments. Out of the one dozen fraudsters involved, all but one individual and six corporations accused in the case have pleaded guilty. A state attorney summed up the efforts best when saying? ”An aggressive multi-agency effort has dismantled a significant health care fraud operation, and sends a clear message to those who rob taxpayer dollars and exploit vulnerable residents that depends on Medicare and Medicaid for care.” (AKA – defraud our system and we will put you in jail.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”New Orleans Health –Care Fraud Prosecution Nets Prison Time for California Man,” written by John Simerman and published by The Times-Picayune on May 24, 2013.

A California man was sentenced in federal court Friday to 40 months in prison and a $25,000 fine for his role in a large-scale scheme to falsify Medicare and Medicaid billings. The scheme, which allegedly netted more than $21 million, also brought convictions early this year against two elderly New Orleans-area doctors, among others.

Jerayr Rostamian, 50, was accused of using a company he owned, Med-Tech, to launder money for the health-care fraud scam. The company also was convicted of money laundering and ordered to pay more than $3.7 million in restitution to the two government insurance programs. U.S. District Judge Lance Africk also ordered the company to forfeit its assets, according to interim U.S. Attorney Dana Boente’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.