Lying Compounds the Problem

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When you know someone is doing something illegal, lying about it is never the right response. (Lying only compounds the problem.)The owners and operators of a Mississippi-based medical supply company that also provided compounded inhalation drugs knew that billing Medicare for compounded inhalation drugs was not allowed. However, they disregarded guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) anyway. (It didn’t take very long before they realized their fraudulent scheme was out of air.)

As a medical provider, the male owner of the company regularly submitted claims to Medicare for inhalation drugs that were compounded, or customized for each patient. As of July 1, 2007, CMS revised their nationwide policy regarding compounded inhalation drugs stating that any claims would be denied as not medically necessary after that time. (Despite this policy, the male owner continued to compound inhalation drugs and bill Medicare as if they were non-compounded drugs.) The woman involved in this case, who happened to be the compliance officer, knew what was going on, but she neglected to notify authorities and concealed the fraudulent billing practices.

Both 60-year-old company officials pleaded guilty for their roles in making false statements to Medicare. The man admitted to making false statements related to a health care matter. The woman admitted to committing a misprision or concealment of a felony.

At sentencing, the man faces a maximum of five years in prison, while the woman is facing three years. Both may be penalized with a $250,000 fine. Congratulations to the investigators who stopped these two fraudsters from further compounding the problem with fraud within the nation’s government health care benefit programs.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”2 plead guilty in Medicare fraud case” posted on WDAM.com on December 22, 2016.

Larry Carlton Jenkins and Annie Elizabeth Jenkins, both age 60, of Stringer, Mississippi, pled guilty on December 16, 2016, for their roles in a case involving making false statements to Medicare, announced U.S. Attorney Gregory K. Davis.

Larry Carlton Jenkins pled guilty to one count of making a false statement relating to a health care matter, while Annie Elizabeth Jenkins pled guilty to one count of committing a misprision of felony.

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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.