Powering a Conspiracy

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For many sales professionals, generating leads is a necessary starting point in the process of making a sale. (However, it’s important to obtain leads in a legal manner before trying to close the deal.) The Jackson Sun tells about two medical device sales professionals who obtained their leads by paying kickbacks to ”runners” who provided them with Medicare cardholders as patients. Their illegal scheme netted them somewhere between $400,000 and $1 million. (That’s a pretty lucrative scam.)

The story states that these two fraudsters, who happened to be married to each other, operated a medical clinic in Mississippi while also working as sales representatives for a local medical equipment company. (How convenient to own the medical clinic that refers patients to the medical equipment company.) The two also paid individuals in their town to disclose potential clients who were qualified Medicare beneficiaries.

The fraudulent duo also forged medical records and signatures from a nurse practitioner to give the appearance that the Medicare recipients they sold power wheelchairs and other medical equipment to legitimately needed those devices. The medical equipment company then sent the claims to Medicare for reimbursement. It is important to note that the patients never actually received medical evaluations confirming their need for the medical equipment. (These aggressive sales professionals definitely took their sales tactics to a patently wrong level in this case.)

And if that wasn’t enough, the couple committed tax fraud by misreporting sales. Certain sales commissions were reported in the wife’s name, when in fact the husband was the salesperson involved in the transactions. (The husband was trying to avoid paying taxes.)

The 62-year-old man and his 45-year-old wife each pleaded guilty to one count of conspiracy to commit health care fraud and to pay illegal kickbacks in a scheme that occurred over two years. The couple is scheduled to be sentenced. They currently face up to five years of imprisonment and a $250,000 fine.

It seems to me that a $250,000 fine pales in comparison to the $400,000 to $1 million that they stole from taxpayers and the State of Tennessee Medicare system. It looks like this couple has been brought to justice and their fraudulent scheme has finally run out of power.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”2 plead guilty to Medicare fraud scheme,” written by Staff and published by The Jackson Sun on Nov. 13, 2015.

A married couple has pleaded guilty to partaking in a scheme to defraud Medicare of more than $400,000 by making fraudulent medical equipment orders and paying illegal kickbacks. Four other defendants are awaiting trial after they were previously indicted in the scheme — three indicted in February and one in October. U.S. Edward Stanton III, of the Western District of Tennessee, announced the guilty pleas in a news release Friday.

According to evidence presented in court, Dennis Sensing, 62, and Brenda Sensing, 45, both of New Albany, Mississippi, partook in a lucrative health care and kickback fraud scheme between 2011 and 2013. On Thursday, the Sensings individually pleaded guilty before Chief Judge J. Daniel Breen to one count of conspiracy to commit health care fraud and pay illegal kickbacks.

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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.