The Music Is Over

297
people, healthcare, stress and problem concept - unhappy woman suffering from headache at home

Music has many associated benefits. It can lower your blood pressure and stress level, make you happier, enhance concentration, improve sleep quality, boost immune systems and, it can even reduce depression and anxiety. The former executive of a community health center in Camden, New Jersey committed Medicaid fraud by billing the government healthcare program for $2.5 million in erroneous claims. (He used some of that money to fund his daughter’s music career, but the fraud gig is over and now he’s singing a different tune.)

The Cherry Hill, New Jersey man founded the non-profit community health clinic to provide mental health services to the Spanish-speaking population in the Camden and North Philadelphia areas. (His illegal song and dance fraud routine was carried out in a variety of ways.)

The executive director was not a soloist, but part of a trio that included his wife, who served as the center’s administrator, and a therapist. Together, they orchestrated a jam session that involved using unqualified employees to provide mental health therapy to Medicaid recipients.

New Jersey’s Medicaid rules require that mental health providers be licensed or possess a Master’s Degree in mental health. However, today’s fraudster and some of his unlicensed and unqualified employees treated qualified Medicaid beneficiaries, then billed the healthcare program as if qualified therapists had treated them. (I bet that struck a dissonant chord with the government.)

The center director also falsified records for mental health sessions by incorrectly stating the amount of time spent in therapy. For example, if a mother received therapy without her child, he billed Medicaid for the mom’s session and then submitted another bill as if he had seen the child. He also billed for incorrect times and falsified medical records to pass Medicaid audits.

So, are you curious as to what he did with the money he embezzled? He liked to gamble in Philadelphia, eat nice meals, and travel domestically and internationally. Court records show that he withdrew $35,000 from the center’s bank account while at a local casino. (I’m sure a few bells went off when that happened.) After his Camden office was raided, investigators found that he had also funded his daughter’s music career and paid “no-show” employees.

The 53-year-old embezzler pleaded guilty to Medicaid fraud and was sentenced to nearly six years in prison to be followed by three years of supervised release. And, he must pay $2.5 million in restitution to Medicaid. His other band members including wife and therapist, also pleaded guilty to similar charges and are awaiting sentencing. (His wife stole $40,000 from the non-profit center that was supposed to provide mental health services for the Camden area’s underserved residents.) It looks like this fraudster’s swan song has been sung. Now he has to face the music.

Today’s “Fraud of the Day” is based on an article entitled, “Cherry Hill man gets 70 months in prison for $2.5M Medicaid fraud,” published by The Inquirer on October 23, 2017.

Cesar Tavera, the former executive director of a community health center in Camden, was sentenced Monday to more than five years in prison for stealing money from the nonprofit, which was created to provide mental health services for the city’s underserved residents.

In addition to 70 months in prison, three years of supervised release was ordered by U.S. District Judge Noel L. Hillman in Camden. The judge also issued a $2.5 million restitution order.

SHARE
Previous articleThe Most Dreaded Time of the Year
Next articleFeigning Fraudsters
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.