Sinking Ship

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Shot of a confident mature woman looking outside trough her window while contemplating at home during the day

There is a maritime tradition that involves the captain going down with the ship. In other words, he is responsible for saving his crew, or he will risk his life in the process. The former owner and medical director of a Baton Rouge, Louisiana pain management clinic was at the helm of a Medicare fraud billing scheme that stole approximately $255,000 from the government healthcare program. His billing manager is the focus of today’s fraud blog, but she’s not the only crew member involved in this fraudulent sinking ship.

The former billing supervisor, who was extremely remorseful during sentencing, was instrumental in submitting false claims showing that minor surgical procedures occurred the day after an office visit so the clinic could be reimbursed by Medicare for two separate visits – the procedure and the office visit. (This practice – called bundling – makes sure they are reimbursed for non-reimbursable office visits, even though it is illegal.)

Today’s fraudster from Baton Rouge pleaded guilty to Medicare fraud. Lucky for her, the judge threw her a life raft when he determined that the woman was “manipulated and controlled” by the former owner or “Captain” of the fraud frigate. Instead of a prison sentence, the 56-year-old was placed on probation and ordered to pay more than $254,000 in restitution.

The 66-year-old doctor, who also previously pleaded guilty to healthcare fraud, received a sentence of 37 months in federal prison for causing nearly $516,000 in fraudulent claims to be filed over a decade. He owes Medicare $255,000 in restitution.

Further research revealed a Department of Defense press release that stated the co-owner of the pain clinic was convicted of healthcare fraud in a separate case involving $336,000 in illegal kickback payments. Another employee, a former physician’s assistant pleaded guilty to illegally distributing oxycodone pills. Thanks to the Medicare Strike Force, the multiple healthcare fraud schemes initiated by the Captain and his crew at this pain management clinic have been captured for pirating government benefits they did not deserve.

Today’s “Fraud of the Day” is based on an article, Ex-Baton Rouge pain management clinic employee put on probation for fraudulent billing,” published by The Advocate on May 22, 2019.

The former billing supervisor at a Baton Rouge pain management clinic was put on federal probation Wednesday and ordered to pay $254,000-plus in restitution for her role in a fraudulent billing scheme.

Charlene Anita Severio, 56, faced a possible prison term after pleading guilty in February, but Chief U.S. District Judge Shelly Dick found that the Walker woman was “manipulated and controlled” by Dr. John Eastham Clark, a former owner and medical director of Louisiana Spine & Sports on Bluebonnet Boulevard

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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.