Certifiably Fraudulent

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When criminals want to steal money from government health care programs, they generally submit lots of fraudulent claims for medical services or products that are not medically necessary nor delivered. Because the government strives to be efficient when paying claims, health care programs tend to issue benefit checks before completely validating the claims. A Department of Justice press release explains how four employees of several medical service clinics in Louisiana conspired to steal nearly $51 million from Medicare by submitting thousands of fraudulent claims. The press release states that the scheme was carried out by two doctors, a nurse and an office manager from several medical service clinics over a ten-year period of time. Two of the co-conspirators claimed that there were thousands of Medicare recipients requiring in-home nursing or therapy services. The nurse falsely certified that the patients were homebound and billed for treatment that did not occur. The office manager and biller at one of the companies paid illegal kickbacks to patient recruiters. (He also submitted claims stating that patients, who were actually holding down a job outside of their home, were homebound and needed medical services.) Over a 10-year period of time, the four defendants submitted more than $56 million in claims to Medicare, most of which were fraudulent. (The government health care program paid $50.7 million for the claims.) After a five-day jury trial, the four defendants ranging in age from 57 to 69 years old were found guilty of their roles in the health care fraud scheme. (They were definitely old enough to know better.) Sentencing is scheduled for the last of 13 people who pleaded guilty in the case. Congratulations are in order for the Medicare Strike Force which included involvement by the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General and the Louisiana Attorney General’s Medicaid Fraud Control Unit. Together, these agencies verified that the defendants were certifiably fraudulent.

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”New Orleans Jury Convicts Two Doctors, a Nurse and an Office Manager for Roles in $50 Million Fraud Scheme,” released by the Department of Justice on May 14, 2015.

A jury in New Orleans convicted four employees of medical service clinics yesterday for their roles in a $50 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth A. Polite of the Eastern District of Louisiana, Special Agent in Charge Michael J. Anderson of the FBI’s New Orleans Field Office, Special Agent in Charge Mike Fields of the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG) Dallas Regional Office and Louisiana Attorney General James D. ”Buddy” Caldwell made the announcement.

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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.