What about the Victim?

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When a fraudster commits a crime against a victim, the victim is harmed and suffers a tangible loss. To help compensate victims for their loss, the Crime Victims Fund was established by the Victims of Crime Act of 1984. Fund dollars are collected from convicted criminals by U.S. Attorney’s Offices, federal courts and the Federal Bureau of Prisons. Compensation is made to or on behalf of the crime victim to cover medical or funeral costs, counseling services or lost wages. Today’s ”Fraud of the Day” from MySanAntonio.com describes a convicted fraudster who had to make a contribution to the Crime Victims Fund for his part in a conspiracy to commit health care fraud.

The man, who operated a medical supply company in California, had a habit of submitting false claims for power wheelchairs and other durable medical equipment that was not provided to Medicare beneficiaries nor was medically necessary. (In fact, the fraudster submitted more than $1.2 million in claims to Medicare through a North Dakota-based contractor, who pays Medicare claims for durable equipment suppliers throughout the State of California.) According to the story, the fraudster would frequently provide Medicare patients with less expensive electric scooters or nothing at all, while claiming that he had provided them with power wheel chairs.

After a five-day trial, the defendant pleaded guilty. The judge sentenced the 66-year-old man to one year of home confinement. He also was ordered to pay $417,811 to the contractor who processed the claim and $100,000 to the government for his fraudulent acts. And, while it wasn’t mentioned in the article, I did a little additional research and found that he also has to pay $100 to the Crime Victims Fund.

He’ll have plenty of time to think about his crime and his victims while serving his home confinement sentence. But, what about the next fraudster who commits this crime and his or her next victim(s)? Let’s start by targeting Medicare fraud up front. So, here’s the question for the day: how would you have identified this crime earlier?

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Los Angeles Man Sentenced in Medicare Fraud Case,” published by MySanAntonio.com on March 3, 2014.

FARGO, N.D. (AP) — A Los Angeles man has been sentenced to home confinement and ordered to pay back more than $400,000 for filing bogus Medicare claims to Fargo-based Noridian Healthcare Solutions LLC.

Rober Ollie pleaded guilty in November to conspiracy to commit health care fraud. The plea deal came on the fifth day of a jury trial.

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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.