Allergic to Fraud

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For allergy sufferers who do not like needles, allergy drops are an alternative to in-office shots. Some research reports show that the benefits of allergy drops can be similar to allergy shots, except most drops are not approved by the Food and Drug Administration (FDA). That’s one of the reasons why today’s fraudster from Sevier County, Tennessee used incorrect billing codes when submitting claims to Medicaid, Medicare and private insurers. (Another reason was greed.) Read on to find out how the Tennessee medical doctor committed millions of dollars in healthcare fraud by prescribing unnecessary allergy drops to patients.

The Gatlinburg, Tennessee physician, who claimed that he was a “good doctor,” knew that the allergy drops he was prescribing and billing for were not approved by the FDA and that his patients really didn’t need them. He lured prospective patients by offering “free” allergy testing in his mobile allergy clinic at employers’ health fairs, senior centers, a tomato festival, flea markets, amusement fairs and car shows. He billed for the unapproved allergy drops and kept on billing without his victims’ permission. (Despite knowing that insurance providers would not cover the charges, he submitted the bills with a code he knew would be accepted.) In all, the not-so-good doc collected $3.5 million from his erroneous claims.

It’s important to note that the Tennessee physician, who was the founder of a chain of walk-in clinics in East Tennessee, was previously convicted of over-prescribing opiates in 1997. (He wrote prescriptions for opiates and narcotics to patients who became addicted to the medications he prescribed.)  Apparently, the doctor who claimed he was addicted to opioids, did not have to give up his license to practice medicine because he received treatment for his addiction. Fast forward to between 2011 and 2015 when the doc began over-prescribing opiates once again.

Despite a shady past, the doctor refused to admit that he intentionally committed healthcare fraud in today’s case. He blamed “conflicting views” on billing practices. (As you might imagine, the judge had a conflict with the physician’s opinion.) The 64-year-old doctor pleaded guilty to healthcare fraud. The defendant’s attorney has requested five years of probation, but the prosecution is recommending 64 months behind federal prison bars. He must also pay $3.6 million in restitution.

It’s ironic that the former medical doctor, who voluntarily surrendered his medical license as part of a plea deal in this case, maintains that the government miscalculated the losses due to his fraudulent claims. (Even though his income from TennCare and Medicare more than doubled from $800,000 in 2012 to $1.99 million in 2013, then increased to $3.7 million in 2014.) The government is quite allergic to fraud, so let’s hope that today’s offender gets the right dose of punishment to serve as an appropriate antidote for future fraudulent actions.

Today’s “Fraud of the Day” is based on an article entitled, “Former doctor feels the effects of his bad medicine,” published by Citizen Tribune on January 22, 2019.  

A former Sevier County medical doctor, who tried to bill Morristown city government more than $200,000 for unwanted allergy treatments and victimized Grainger County Tomato Festival-goers, is getting hurricane-force blowback in an effort to minimize his role in a multi-million-dollar insurance scam, according to court documents.

Robert M. Maughon, 64, has already pleaded guilty to health-care fraud and agreed to pay approximately $3.6 million in restitution. Assistant U.S. Attorney Brent E. Slabbekorn is recommending 64 months in federal prison. Maughon’s attorney is asking for a five-year probationary sentence.

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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.