Sleight of Hand

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32597944 - surgical life

Orthopedic surgery is a fulfilling field of work for doctors who like the instant gratification of repairing someone. (The highly specialized discipline requires a great deal of dexterity in their hands.) An orthopedic surgeon from Utica, New York used his specialized skills to perform a “sleight of hand” trick on the New York State Workers’ Compensation Board. He committed workers’ compensation fraud by operating an illicit medical billing mill while vacationing out of the country and claiming to be in multiple places at the same time.

The orthopedic surgeon also carried out his scam while travelling to Upstate and Western New York to perform medical exams related to workers’ compensation claims. At the same time, he was simultaneously billing for medical services back in his Utica office. (Call me crazy, but you can’t be in two places at one time, unless it’s on paper.)

 The New York State workers’ compensation program had a slight problem with his many claims that enabled him to collect nearly $87,000 he was not entitled to receive. (He was legally required to be physically present for the exams back in his Utica office.)

While the orthopedic surgeon was elsewhere giving exams, his physician’s assistant (PA) back in the Utica office examined and treated his workers’ compensation patients without his direction. (As you might guess, that is not allowed for many reasons. What if the PA incorrectly diagnosed the patient, who then did not receive the correct treatment and their condition worsened?)

While the doctor was either traveling across the state or vacationing abroad in Iceland, he unlawfully billed for services worth more than $50,000 to the state’s workers’ compensation program. (Investigators determined that over nearly a three-year period, he was only in the Utica office for approximately 150 days.)

The 70-year-old doctor from Clinton, New York pleaded guilty to workers’ compensation fraud and was ordered to surrender his medical license. When sentenced this summer, he is expected to have to repay $86,996.31 in restitution to the state’s workers’ compensation program.

While a well-performed “sleight of hand” looks like a completely natural gesture, this man’s billing manipulations were sloppy. Congratulations to the New York State Workers’ Compensation Board for catching this fraudster in the act and shutting down his medical billing mill.

Today’s “Fraud of the Day” is based on an article entitled, Utica-based surgeon pleads guilty in fraud case,” published by the Rome Sentinel on April 12, 2018.

A Utica-based surgeon accused of repeatedly trying to defraud the state Workers’ Compensation program pleaded guilty in County Court on Tuesday and has been ordered to surrender his medical license.

Dr. Gregory B. Shankman, 70, of Clinton, pleaded guilty before Judge Robert L. Bauer to two counts of second-degree offering a false instrument for filing, authorities said. Shankman’s case was adjourned for sentencing to June 5.

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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.