The Sobering Effect of Fraud

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Sober living environments (SLEs) – often referred to as halfway houses – are interim facilities where people recovering from substance abuse can work on returning to their former lives. An article published by The Boston Globe follows the story of a doctor who paid kickbacks to halfway house managers in order to falsely bill Medicaid for millions in drug screening tests for SLE residents.

The doctor ran the drug screening scheme through his medical practice, which had 29 branches, including laboratories across the Commonwealth of Massachusetts. He obtained patients by paying kickbacks to sober SLE managers, who encouraged their residents to have their urine screened through his practice. (This was a lucrative business opportunity seeing that each resident was required to be screened at least three times a week. The doctor could bill Medicaid for between $100 and $200 per screen.)

In order to bill Medicaid for the drug screens, the doctor allowed the names of other practice physicians and nurses who were not actually treating the patients to be used on the claim forms. It is important to note that state regulations require that the providers deem the drug screening to be medically necessary and be physically present and actively involved with the patient’s treatment. (As you might guess, the tests were not medically necessary nor were the medical professionals present for the tests.)

The 64-year-old doctor pleaded guilty and was sentenced to 11 months in jail. He also will pay restitution of $9.3 million. Two of the SLE managers were sentenced to suspended terms of two years each. The cases of two other house managers allegedly involved in the scheme are ongoing.

For those people addicted to drugs and alcohol, Medicaid funds can mean the difference between life and death. Maybe in the beginning this doctor opened his practice to serve those people suffering from addiction, but unfortunately over time, it looks like he became addicted to Medicaid fraud. (Let’s hope that the prison sentence handed down plus the millions in restitution required will have a sobering effect upon this fraudster.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Brookline Doctor Sentenced to Jail, Fined for Medicaid Fraud,” written by Jack Newsham and published by The Boston Globe on April 7, 2015.

A Brookline doctor has been sentenced to 11 months in jail and ordered to pay $9.3 million for running a Medicaid fraud scheme.

Dr. Punyamurtula Kishore and his statewide chain, Preventive Medical Associates, Inc., were found guilty of fraudulently billing MassHealth for unnecessary drug tests. According to the state, Kishore collected urine samples from drug treatment centers across the state and billed the Medicaid provider for testing them, even though the people who provided the samples weren’t being treated by his clinics and the tests weren’t medically necessary.

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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.