Tightly Knit

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Families who are tightly knit do lots of things together such as run marathons, take nice vacations, and even start businesses together. Today’s fraudster, who was an attorney from Grand Prairie, Texas, opened several businesses with family members with the sole intent to defraud. The attorney ran an organized crime scheme that stole more than $26 million from the U.S. Department of Labor (DOL). He pulled off the intricate healthcare fraud and workers’ compensation fraud scam with the help of his wife, sister and niece.

The Texas lawyer, who had family ties in Zimbabwe, used his former employer, who was also a criminal, to hide his scheme behind. The boss, a former chiropractor, owned a Texas-based clinic specializing in the treatment of workplace injuries. The company treated patients covered by the Federal Employees’ Compensation Act (FECA) and targeted unionized postal workers in the Austin and San Antonio areas, plus Civilian Army employees in the Corpus Christi area.

The former owner and his wife scammed the DOL program by overcharging the Office of Workers’ Compensation Program (OWCP) by about $18 million for services and supplies provided to patients covered by the FECA program. The former chiropractor is currently serving 14 years in prison for his crime. (And, that’s where today’s fraudster got his grand idea.)

The Grand Prairie lawyer worked as an attorney for the company that had medical treatment centers in Austin, Corpus Christi, Killeen and San Antonio. He used his employer as a conduit for bilking the DOL FECA program until the wife of the chiropractor fired him. (That’s ironic since she and her husband were also scamming the DOL. Perhaps she was mad because she didn’t think of his scam first or he didn’t share the proceeds.)

The lawyer used his niece, who happened to work as an intern for the DOL, to carry out his scam. (She also worked for her uncle’s medical billing companies.) She stole more than 250 claim numbers from the agency’s computer system and shared them with her uncle and other co-conspirators, who were also family members. The lawyer, his wife and his sister opened three medical equipment companies for the sole purpose of submitting exaggerated or fake claims to the FECA program using the stolen personal information. (Patients were billed for duplicate or unnecessary medical equipment services or items that were not associated with claimant injuries.)

Most of the nearly $30 million he stole went to family members in Zibabwe. (His sister used some of the stolen funds to buy construction equipment from a seller in Maryland. She then shipped it to a family business in Zimbabwe.)

The 55-year-old Grand Prairie former attorney was sentenced to 10 years in federal prison for filing false claims for durable medical equipment with DOL’s OWCP. He was ordered to pay $26.5 million in restitution for the healthcare fraud and workers’ compensation fraud scam that lasted four years. The fraudster and his co-defendants forfeited $375,000 along with three vehicles, two real estate properties and $8.3 million seized from 25 bank accounts. Three family members including his wife, 47, his sister, 63, and his niece, 30, are awaiting sentencing. (The former lawyer even tried to recruit his 84-year-old mother and sister-in-law to participate in the scam, but there were no charges filed against them.)

You might find it interesting to know that the lawyer’s license is currently suspended, even after a public reprimand and four previous suspensions. (Revoke it already!) This man used his license to practice law as a license to steal taxpayer dollars that were intended for the treatment of injured federal workers. (Congratulations to Department of Labor for unraveling this once tight-knit family’s fraudulent scheme.)

Today’s “Fraud of the Day” is based on an article entitled, Dallas lawyer who planted niece in government job to serve as ‘mole’ gets 10-year max for medical fraud,” published by The Dallas Morning News on April 19, 2018.

To bilk a government health program out of nearly $30 million, Dallas lawyer Tshombe Anderson and his family members used trickery and outright fraud, prosecutors say.

Anderson had his niece obtain an internship at the U.S. Labor Department so she could snoop through claims files, learn the system and act as a “mole.” And Anderson, his wife and his sister formed businesses to bill the federal worker’s compensation program for unnecessary medical equipment that in some cases wasn’t even provided, according to federal prosecutors.

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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.