It would be prudent for doctors to make sure that their billing staff kept detailed patient records, particularly when submitting claims to Medicare. A Houston doctor may have put too much trust into his staff’s abilities when he signed off on unnecessary tests for approximately 400 Medicare patients. (He’s about to pay a steep price for being a ”hands-off” kind of boss.)

The Houston neurologist was one of eight co-defendants involved in this particular Medicare fraud case. The doctor’s part was to order electrocardiogram and breathing tests, then allow his staff to bill Medicare. (There was just one problem, the patients didn’t need the tests that were ordered.)

Apparently, the doctor did not realize that the patients he saw had been recruited by marketers who split a $100 kickback. (The kickback was paid by the mastermind of an even larger scheme to defraud Medicare.) The physician’s lawyer claimed that the neurologist worked at the clinic two days a week, and only had interaction with the patients once inside the exam room. (He didn’t see the patients arrive with the marketers. And the clinic’s records were not so good either. No appointment book was kept.)

After hearing six days of arguments, a federal jury convicted the 64-year-old physician for his role in the $13 million Medicare billing scheme. Seven co-defendants also pleaded guilty to their involvement in billing patients for unnecessary tests. (The master mind behind the scheme and the clinic director were two of the scam participants that admitted guilt.)

The defendant’s lawyer explained to the jury that the doctor was extremely naive. (If that’s true, I have some ocean front property to sell you in Idaho.) I’m guessing that when sentenced, the government will make sure that the doctor understands that he needs to keep his hands off of Medicare funds he doesn’t deserve.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Houston doctor convicted in Medicare fraud,” published by the Houston Chronicle on January 25, 2017.

A Houston physician was convicted in federal court Wednesday for his role in a $13 million fraudulent Medicare billing scheme involving hundreds of patients-for-hire.

Eight co-defendants – including the clinic director – had admitted to helping bill for unnecessary tests for the patients who were recruited and delivered to the clinic by marketers, according to testimony.

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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.