Another Piece of the Fraud Puzzle

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One of the largest Medicare fraud schemes in history bilked the government of approximately $375 million over a six-year period and allegedly involved 11,000 home health care patients and 500 health care agencies. According to an article in D Healthcare, another piece of this enormous fraud puzzle was solved when a Texas man was sentenced for his part in the scam against the government benefits program.

The story states that a 57-year-old man worked for a durable medical equipment company. He partnered with an owner and operator of another durable medical equipment company, who paid him kickbacks to forge a doctor’s signature on prescriptions and certificates of medical necessity. His forgery cost Medicare more than $580,000. The forged doctor’s signature belonged to the man who is accused of being the mastermind behind one of the largest Medicare fraud scams in history. (The scheme was so big that home health care agencies in Dallas and Houston were not allowed to bill the Centers for Medicare and Medicaid Services (CMS) for six months.)

The forging fraudster pleaded guilty to one count of conspiracy to commit health care fraud and will be required to pay $317,779 in restitution. The co-conspirator owner of the other durable medical equipment company is already serving a 36-month federal prison sentence related to this case. The article states that the criminal will be deported following his prison term. The man, allegedly in charge of the single largest fraud amount orchestrated by one doctor, has a trial set for January 2015.

In this case, there were many co-conspirators involved, making it a very complex case to solve. Just as there are many pieces required to make one puzzle picture, the Medicare Strike Force will continue to track down criminals until they get the picture that fraud will not be tolerated. Let’s hope those who are convicted get the sentences they deserve.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Man Ordered to Pay $74,000 in Medicaid Fraud Case,” written by Dave Kolpack and published in The Bismarck Tribune on April 28, 2014.

FARGO — A North Dakota man accused of lying about his mother’s finances so she would qualify for Medicaid benefits was ordered Monday to reimburse the government for her expenses and pay a civil fine.

Authorities say Donald Hochhalter, 65, of New Leipzig, understated the value of his mother’s assets so she would qualify for government payments when she moved into a nursing home. He pleaded guilty to a misdemeanor charge of making false statements.

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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.