At Risk

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There’s no doubt that fraud puts the integrity of taxpayer-funded health care programs at risk. And when at-risk children are victimized in the process, you can bet that the government will not hesitate to go after those responsible for the crime. That’s what happened to a man who used the identities of several thousand children to fraudulently bill the North Carolina Medicaid program.

Here’s how it happened. Over a two-year period, a 37-year-old man billed Medicaid and other Medicaid managed care organizations for services that were not provided by a variety of outpatient behavioral health providers. He used the stolen identities of more than 2,000 minor children to submit the false billings.

This man’s criminal efforts enabled co-conspirators – other participating providers – to collect more than $5 million from the illegal scheme. (He received $300,000 of the proceeds for his part.) The good news is that government investigators caught the fraudster in action on audiotape coordinating the billing fraud with a Medicaid provider. (Be careful what you say, you never know who is listening.)

Today’s ”Fraud of the Day” criminal ended up pleading guilty to health care fraud conspiracy and aggravated identity theft. (That’s a good thing since the evidence was definitely incriminating.)He was sentenced to nine years in federal prison to be followed by three years of supervised release. In addition, he must also pay $5,722,364.09 in restitution to his victims including the North Carolina Medicaid program and a physician, whose name and identification number were used to commit the fraud. (He also has to give up his truck, boat and boat trailer.)

This fraudster’s scheme was related to another case involving health care fraud and money laundering. The case resulted in that defendant being sentenced to 20 years in federal prison for his role in the health care billing conspiracy. With these two criminals now serving lengthy sentences, there’s no doubt that the government has made a statement on what happens to those who try to victimize at-risk citizens.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Pitt Co. Medicaid biller sentenced to 9 years,” published on Reflector.com on December 13, 2016.

A Greenville man who pleaded guilty to health care fraud conspiracy and aggravated identity theft was sentenced Tuesday to nine years in federal prison.

The United States Attorney’s Office for the Eastern District of North Carolina announced in a Tuesday news release that Donnie Lee Phillips II, 37, was sentenced in federal court to 108 months in federal prison and three years of supervised release.

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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.