The Dangling Carrot

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There are lots of ways to motivate action. Incentives, such as cash or luxury items, can definitely encourage people to perform better. (Dangling an expensive ”carrot” in front of some people can motivate them to perform better; however, it can also backfire, causing others to commit a crime in order to get what they want.) Likewise, fear can also cause people to take action. An article published in The Chicago Sun-Times explains how one doctor was motivated by fear to defraud the Medicare program. (The dangling carrot in this case was $4 million in Medicare reimbursements.)

The story states that a suburban doctor, who was an employee and part owner of a business that provided comprehensive medical care to homebound patients, received referrals from other home health agencies in exchange for providing certification that the patients were confined to their home. (This is a good example of quid pro quo gone wrong.)

Apparently, over about three years, the doctor falsely provided confirmation that patients were homebound when in reality, 20 percent were not. Regardless of the fact that many of the services were not medically necessary, the physician billed Medicare as if they were, and subsequently he received $4 million from the government health care benefits program.

The 62-year-old pleaded guilty to Medicare fraud and now faces up to 10 years in prison. (That is probably not the way he envisioned spending the last few years of his career.)

The author of the article explains that the doctor was fearful that if he stopped providing the fake certifications, the referrals would stop. (Obviously, letting his fear spin out of control, he most likely thought his business would fail. Perhaps it was the doctor’s lifestyle that motivated him to continue the illegal scam.) Because of this criminal’s actions, Medicare paid more than $20 million for the fraudulent certifications. (That’s a lot of money that didn’t reach those who qualified to receive medical assistance.) There’s a good chance that this man’s worst fears have come to fruition now that he is facing a lengthy term behind bars.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Bloomingdale Doctor Pleads Guilty to Medicare Fraud,” published by The Chicago Sun-Times on September 8, 2015.

A northwest suburban doctor pleaded guilty in federal court Tuesday to a Medicare fraud scheme that caused losses to the program of at least $4 million.

Dr. Arthur Davida, 62, who was an employee and part-owner of Bloomingdale-based Home Care Physicians Inc., pleaded guilty to the health care fraud charge and faces up to 10 years in prison, according to a statement from the U.S. Attorney’s office.

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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.