Everything (including conspiracy) is Bigger in Texas

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Getting injured on the job is something that can happen to anyone who is required to perform physical labor. (Companies pay into workers’ compensation insurance programs to protect the viability of their business as well as their employees.) An article in The Dallas Morning News tells about 28 people who allegedly participated in a worker’s compensation fraud conspiracy that bilked $8.7 million from the government and honest taxpaying citizens.

The story states that the people allegedly involved in this fraud scheme included doctors, medical providers, independent claims consultants, a former government claims examiner and 21 people who said they had injuries preventing them from returning to work. The alleged 28 willing participants requested $9.5 million in workers’ compensation reimbursements and received $8.7 million for their fraudulent efforts. (That’s more than a 90 percent success rate, certainly great odds for the alleged fraudsters.)The article explains that some of the injured workers received up to 75 percent of their old salaries, a few even receiving lump sums of six figures.

According to the story, the operator of multiple healthcare facilities in the Dallas metropolitan area issued bribes to further his scam. The operator had a knack for talking his co-conspirators into submitting claims for procedures that were more expensive than the services received. (Apparently, some of these scam participants knew what they were getting into, but tried to preserve their integrity once federal investigators began examining their workers’ compensation requests. If you think you can save face after taking a bribe, I don’t know how much integrity you had to begin with.) On the other hand, others supposedly did not understand what they were signing up for, nor realize they were involved in a conspiracy to defraud workers’ compensation insurance. (If you take or receive payments that you don’t deserve, but you aren’t raising serious questions about them, how innocent can you really be?)

Workers’ Compensation Insurance pays injured workers who are unable to fulfill their job responsibilities until they are able to work again. But as is the case with most government benefits programs, where free money flows, there will always be fraudsters looking to tap the supply of available government funds. All 28 of the people involved in this investigation have agreed to plead guilty to their involvement in the healthcare fraud scheme, and more could be charged in the coming months. (Hopefully, these agreements pan out in front of a judge, and the federal government and taxpayers can receive their rightful restitution.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Feds file charges against 28 in ‘sprawling health care fraud scheme’ in Dallas area,” written by Jeff Moiser and published by The Dallas Morning News Crime Blog on Nov. 16, 2015.

Federal prosecutors announced Monday they’ve filed criminal charges against 28 people involved in a ”complex and sprawling health care fraud scheme” that cost the government $8.7 million.

All 28 have signed documents indicating they would plead guilty, according to the U.S. Attorney’s office in Dallas. Others could still be charged.

”This office will continue to vigorously pursue those who fraudulently obtain benefits at the expense of those who have a legitimate need,” said John Parker, U.S. Attorney for the North District of Texas, in a written statement.

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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.