Circumventing Fraud

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Fraudsters are not usually ones to follow the rules and are quite adept at circumventing systems put in place to prevent government benefits from falling into the wrong hands. An article published by the Livingston Daily tells about a Medicare fraud scheme involving 20 Detroit-area residents who worked together to submit more than $34 million in false bills to the program.

The story reports that the alleged co-conspirators all had a role in the alleged health care fraud scheme through their positions as physicians, owners and operators of related companies, office employees and patient recruiters. (It’s no surprise that altogether they are accused of submitting fraudulent claims for chiropractic and psychotherapy services that were never rendered.)

The primary person mentioned in this article co-owned and operated a company that provided billing and enrollment services to Medicare providers. She had a little help from another co-defendant who acquired the Medicare numbers of licensed medical service providers. (These PINs enabled her to circumvent the prepayment review process through yet another partner in crime, a doctor. Confused yet? This was a pretty big scheme.) The woman was responsible in some part for submitting more than $1.1 million in fraudulent claim submissions. (According to the story, Medicare paid approximately $402,000 for the bogus claims and the two women received about seven percent or $28,000 for their criminal efforts.)

The 55-year-old billing company owner pleaded guilty to conspiracy to commit health care fraud. She is facing up to 10 years in prison plus a three-year parole term. The doctor, who helped her get around the prepayment review, is charged with health care fraud and conspiracy to commit health care fraud. His case is pending while awaiting a new trial date. He is presumed innocent. Another co-defendant in the case who was an unlicensed physician faces sentencing for conspiracy to commit health care fraud.

While fraudsters often try new ways to circumvent the long arm of the law, it always manages to reach out and stop fraudsters in their tracks as evidenced by this case, with those who have been convicted. Let’s hope these 20 co-defendants have all received this important message about defrauding the government – don’t even try to get around the system Ì? you and anyone who tries to help you take undeserved benefits will be caught.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Woman Admits to Medicare Fraud,” written by Lisa Roose-Church and published by the Livingston Daily on September 9, 2015.

A January sentencing date has been set for a Pinckney woman who pleaded guilty to her role in a scheme to submit more than $34 million in false billing to Medicare.

Michelle Freeman, 55, was among 20 Detroit-area residents charged for their alleged role in a health care fraud scheme involving claims for chiropractic and psychotherapy services. She pleaded guilty Sept. 1 to conspiracy to commit health care fraud, which carries a penalty of up to 10 years in prison and a three-year parole term.

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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.