What’s Behind Door #1, #2 and #3?

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The popular American television game show “Let’s Make a Deal” made peering behind closed doors popular as participants had to decide whether to keep something they had been offered, or exchange it for something else behind three closed doors. (Obviously, the “traders” didn’t know if they were going to get something of value or be duped into taking something they didn’t want.) Today’s article highlights a group of fraudsters from Texas who committed Medicare Fraud by operating their nearly $60 million scam behind the doors of three healthcare companies.

Six co-defendants carried out their ruse through three separate companies that were co-located behind the doors of company #1, which provided home visits by licensed physicians. One of the codefendants had ownership of all three companies. (Companies #2 and #3 provided similar services as #1.)

The Dallas, Texas woman who owned all three companies, owned company #1 with a licensed physician. Another male co-defendant and the same woman set up company #2. (However, it was purchased by a “straw” buyer to conceal the woman’s identity so Medicare would not make the connection to the multiple businesses.) Company #3 was co-owned with another female co-defendant, who had Medicare billing oversight. While all three companies appeared to be separate entities, they all worked as one. (The six co-defendants received paychecks from all three companies.)

The two physicians in the fraud squad provided their Medicare number for certifying the submission of Medicare claims for all three companies. For more than four years, the two physicians certified 94 percent of the Medicare beneficiaries receiving home healthcare services from company #1. And more than 97 percent of this company’s patients received home healthcare whether it was needed or not. (If Medicare had known about the improper relationships between the three companies, the government would have never allowed them to enroll in the program and bill for services.)

Claims were submitted using the two physicians’ provider numbers regardless of who performed the services. (Apparently, bills were submitted at an alarming rate charging for 90-minute doctor visits even though the appointments only lasted between 15 and 20 minutes.) The multitude of false certifications caused Medicare to pay out more than $40 million for fraudulent home health services.

The 62-year-old female from Dallas, Texas, who had ownership in all three companies, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to 10 years in prison. (She was happy about duping the government until she received a surprise behind court room doors. She now owes $51,497,903.87 in restitution.)

One of the physicians received a 30-month sentence behind bars and was ordered to pay $18,309,171.21 in restitution. The other doctor was convicted of Medicare Fraud after a 5-day trial on one count of conspiracy to commit healthcare fraud and six counts of healthcare fraud and is awaiting sentencing. The female medical biller, 70, pleaded guilty to Medicare Fraud and was sentenced to two years in prison and ordered to pay $4,193,655.78 in restitution. The other two co-defendants have also pleaded guilty to their roles in the scheme and are awaiting sentencing. Unlike game shows where there are winners and losers, fraud usually always ends in losers.

Perhaps the moral of today’s story is that when fraud comes knocking on your door, don’t answer, even if it promises a wonderful prize. It looks like these co-defendants will soon find out what’s behind a whole row of prison cell doors.

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, Doctor & Owner of Multiple Home Health Companies Sentenced in a nearly $60 Million Medicare Fraud Scheme,” released on August 18, 2017.

DALLAS – Myrna S. Parcon, a/k/a “Merna Parcon,” 62, of Dallas and Ransome N. Etindi, 57, of Waxahachie, Texas, were sentenced yesterday by U.S. District Judge Jane Boyle for their role in a nearly $60 million Medicare fraud scheme, announced U.S. Attorney John Parker of the Northern District of Texas.

Parcon and Etindi each pleaded guilty to conspiracy to commit health care fraud. Judge Boyle sentenced Parcon to 120 months in prison and ordered her to pay $51,497,930.87 in restitution. Judge Boyle sentenced Etindi to 30 months in prison and ordered him to pay $18,309.171.21 in restitution. They are scheduled to surrender to the Bureau of Prisons on September 20, 2017.

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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.