A Trail of Deception

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Where there is fraud, there is deception. Criminals attempt to deceive their victims by making things appear to be authentic, when in reality they are not. The News-Press details the story of two fraudsters who deceived Medicare by billing for more than $28 million in fraudulent claims.

The story states that over a five-year period, the owner of four physical therapy and rehabilitation clinics and a co-conspirator used patient and physician information to create and submit bogus Medicare claims for therapy services that were never prescribed or provided. (The owner apparently forged patient records to cover his trail of deception.) Medicare paid about $14.4 million for the false claims.

The 53-year-old had a good thing going (so he thought), so he expanded his deception to include a network of other therapy clinics to bring in more money. The article reports that he submitted false claims for the additional clinics for a 20 percent kickback from the Medicare reimbursements received. (He was quite industrious.)

As you can imagine, it can be difficult to keep up a ruse, so the fraudster sold his clinics to Cuban immigrants to remove his connection with the Medicare fraud. (I wonder if they knew what they were getting into.)

Needless to say, the trail of deception ended shortly thereafter when the fraudster pleaded guilty to health care fraud. He faces a prison sentence of up to 15 years and has agreed to pay full restitution. It looks like his punishment fits the crime. He will also be excluded from all federal health care programs –

Medicare and Medicaid included. Plus, he faces a fine of $500,000 and a six-year supervised release.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Owner of Fort Myers Rehab Clinic Pleads Guilty to Medicare Fraud,” written by Marissa Kendal and published by the News-Press on February 3, 2014.

The owner of a Fort Myers rehabilitation center faces up to 15 years in prison for scamming Medicare out of tens of millions.

Luis Duluc, 53, formerly of Southwest Florida, pleaded guilty in federal court Monday to conspiracy to commit health care fraud and making a false statement relating to health care matters, according to a Department of Justice release.

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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.