Over and Above

18

Fraudsters are in business to make as much money as quickly as possible. Therefore, it is highly unlikely that they would submit claims to a government health care program undercharging for services. The owners of a non-emergency medical transport company went over and above in their efforts to defraud the Illinois Medicaid program of $4.7 million by submitting false bills for transportation services that were not provided.

The man who owned the medical transport company and a female employee overbilled the state ‘s Medicaid program not only for services not rendered, but also for mileage over and above the number of miles that were actually travelled.

The court found evidence that the medical transport company submitted bills in the names of deceased people plus patients who happened to be in the hospital based during the time individuals were approved for transportation. There were also times when the company billed for more riders than the ambulance could transport. (It sounds like the company was out for a joy ride.)

The company owner and his employee also broke the rules on mileage clearly stated in the Medicaid handbook. The program only allows non-emergency transport companies to bill mileage for the first rider. (The owner directed his staff to incorrectly bill for mileage, sometimes billing mileage to all riders and other times, billing for every fourth rider. He was counting on the government not delving too deeply into his illegal billing procedures.)

The 68-year-old medical transport company owner received a five-year prison sentence and was ordered to pay $4.7 million in restitution. His 44-year-old co-owner was sentenced to 30 months in prison for her role in the scheme and must pay $4 million in restitution.

While the punishment in this case seems fair enough, what isn’t fair is the damage done to the program and the victims of this crime. While these two criminals did their best to get away with as much money as possible, the government caught them in the illegal act and prevented them from driving away with government health care funds they did not deserve.

Source: Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Co-owner of Chicago Medical Transport Company Sentenced to Five Years in Prison for Overbilling Illinois Medicaid $4.7 Million,” released on January 25, 2017.

SPRINGFIELD, Ill. ‚ A Chicago man has been sentenced to five years in prison for fraudulent overbilling an estimated $4.7 million to Illinois’ Medicaid program for non-emergency medical transport. Gregory D. Toran, 68, of Hazel Crest, Ill., was also ordered to pay $4.7 million in restitution. U.S. District Judge Sue E. Myerscough, who sentenced Toran on Jan. 23, allowed Toran to remain on bond until the federal Bureau of Prisons directs him to self-report to a prison facility to begin his prison sentence.

Toran owned IBT Transportation, LLC., a non-emergency medical transport company, with Tina Kimbrough, 44, of Berwyn, Ill. In August, Kimbrough was sentenced to 30 months in prison for her role in the scheme. Kimbrough previously pled guilty to participating in the conspiracy with Toran. Kimbrough was also ordered to pay $4 million restitution, due jointly and severally with Toran.

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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.