Adjusting to Fraud

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Children like pretend play. They can be whomever they like including warriors, princesses, veterinarians or even grocery store clerks. (I doubt many kids pretend to be a fraudster.) At some point, they grow out of that stage and move on to reality. A story published in the Daily Herald tells about a husband and wife team who took ”pretend play” a little too far and acted as friends to their victims so they could carry out a $1 million health fraud scheme.

The article states that the husband provided chiropractor services at five locations near Chicago. Over a period of six years, he caused 376 bogus insurance claims worth more than $4.2 million to be submitted. He received $865,000 for the fraudulent claims. (The crime was probably hard to detect across multiple offices.)

The fraud business was good for the chiropractor, so he included his fitness instructor wife as an accomplice about three years into the scheme. The story states that she convinced her students, who experienced pain or injury after taking her classes, to get treated by her husband. (Now that’s a lucrative referral plan if I ever saw one.) With his wife’s help, the chiropractor was able to bill for an additional $1.6 million for services he never provided. (He racked up another $328,000 from those poor victims.)

These two must have been pretty confident in their ability to hide their crime because even after they were indicted, they continued to submit nearly 600 more fraudulent claims, collecting $160,000 for their criminal efforts. Their illegal acts caught up with them though, and the two pleaded guilty to health care fraud in the end.

The 45-year-old chiropractor was sentenced to eight years in prison, while his 43-year-old wife got 28 months followed by six months of home detention. The husband was ordered to pay $1,029,865 in restitution and his wife was ordered to give back $493,132 to the victim insurance companies, as well. (Further research revealed that some of the insurance companies provided health care coverage through union health and welfare funds they administered in the Chicago area.)

It looks like the chiropractor and his wife are in for a different kind of life now. There will be no more fitness workouts or physical adjustments, only cramped conditions with plenty of time to reflect on the pain and suffering they inflicted on others. (It’s also a pretty safe bet that these two aren’t going to get too many invitations for play dates in the future. My guess is that they don’t have any friends left.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Chiropractor, Wife Sentenced for Health Fraud Scheme,” published by the Daily Herald on September 3, 2014.

A former Lake in the Hills chiropractor and his fitness instructor wife were recently sentenced to federal prison for a $1 million health fraud scheme, officials said.

Andrew Carr, 45, was sentenced to eight years at a hearing last week, while Wendy Carr, 43, received a 28-month sentence on Wednesday for the scheme that they continued for a year after they were indicted in 2011, the U.S. attorney’s office said in a 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.