Fraud-bound

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58435332 - medical doctor writing prescription on white isolated background

Patients who are confined to their homes because of their medical disabilities are considered to be homebound. (Venturing out of the safety of their home environment usually requires an enormous amount of effort and a great deal of assistance in most cases.) An article posted on NOLA.com tells about the owner of a New Orleans medical clinic who directed her employees to falsely certify that patients were homebound and in need of home health care services.

The story states that for more than seven years, the owner and operator of the medical clinic submitted Medicare claims for patients who did not need home health care services. (To be exact, she submitted $49,989,323 in Medicare claims for home health services that were not medically necessary nor provided.)

The clinic operator teamed up with a co-conspirator who happened to manage financial and accounting services at her multiple clinics. The man paid patient recruiters for Medicare beneficiary information, which was then sold to the clinic operator. She used that information to file the fraudulent claims.

As if that were not bad enough, the two also falsified tax and employment records after they were served a federal grand jury subpoena. (They were hoping to throw the jury off track by hiding the patient recruiter kickbacks. And as you might guess, it didn’t work.)

The clinic owner and her accountant both pleaded guilty to one count each of conspiracy to commit health care and conspiracy to falsify records. The 58-year-old woman and the 48-year-old man are scheduled for sentencing. It is important to note that these two perpetrators are connected to 13 other people involved in the Medicare fraud scheme. Eight others, including two doctors employed at the medical clinic, have pleaded guilty.

Congratulations to the Medicare Strike Force for setting boundaries with the criminals involved in this case. They will no longer be able to steal benefits that are meant for homebound patients and it looks like these two fraudsters are now fraud-bound by their own illegal actions.

 

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Medicare Clinic Employees Plead Guilty in $50 Million Medicare Fraud Scheme,” written by Heather Nolan and posted on NOLA.com on March 18, 2015.

Two employees of a New Orleans medical clinic pleaded guilty Wednesday (March 18) in federal court to participating in a $50 million Medicare fraud scheme, according to U.S. Attorney Kenneth Polite’s office.

Paige Okpalobi, 58, of Slidell, and Christopher White, 48, of Destrehan, pleaded guilty to one count each of conspiracy to commit health care fraud and conspiracy to falsify records in a federal investigation.

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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.