Beached

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47600539 - stethoscope head lying on medical forms on clipboards closeup while medicine doctor working in background. health care, insurance and help concept. physician ready to examine patient

Sailors used the commerce-friendly trade winds and associated ocean currents to navigate their early sailing ships from European and African ports to the Americas, bringing goods to trade and sell. Today’s fraudster, who managed the Rockland, Maine-based Trade Winds Health, Swim and Tan Club, thought his healthcare fraud scam, which involved erroneously billing private and government healthcare programs, would be smooth sailing. Unfortunately, it was more than just the rocky Maine coastline and murky waters of fraud that left his deceptive scheme beached.

Several things are interesting about today’s fraud article in addition to our fraudster’s crimes. First, the National Oceanic and Atmospheric Administration (NOAA) refers to trade winds as the “prevailing easterly winds that circle the Earth near the equator.” (Rockland, Maine is nowhere near the equator and if you’ve ever been in Maine, those winds are not usually very warm.) Second, I find it amusing that today’s fraudster worked for a Health, Swim and Tan club. (The fact that the words “health” and “tan” are included in the name of the establishment are ironic, but I digress. Let’s move on to the case at hand.)

The subject of today’s fraud article began work at the Maine health club as an athletic trainer. Approximately three years later, he was promoted to manager and executive director of the health club and its physical therapy practice, which was a separate entity. While in that position, the former athletic trainer supervised the practice’s physical therapists and assistants. He was also put in charge of purchasing, billing and scheduling for the business. (That’s when he got the idea to inflate bills and charge for services not provided so he could pad his pockets.)

Over approximately two years, the manager billed $175,000 in false claims to Medicare, MaineCare, Anthem Blue Cross and Blue Shield and a healthcare program associated with the Department of Veterans Affairs. For some of the false claims, he exaggerated the amount of time therapists spent with patients and for others, he billed for cancelled appointments or for services rendered by unlicensed individuals. (He also billed for physical therapists who were not working on the date of service claimed.)

The article states that the Rockland, Maine man embezzled more than $26,000 from the health club via an associated credit card. He made purchases on Amazon.com and allegedly stole $4,500 in cash that should have been deposited in the health club’s bank account. (Maybe he wanted to vacation down where the trade winds blow and that’s why he stole the money. Who knows?)

The 42-year-old man from Maine, who worked for the health club for nearly 14 years, pleaded guilty to healthcare fraud and embezzlement. He is facing a rough ride that may include spending a decade in prison and paying a fine of up to $250,000 for each count. (I’m guessing this voyage to sentencing may cause him to get a bit seasick.) It’s hard to know which way the winds will blow when this fraudster is sentenced, but it’s a good guess that he is not headed toward the warm waters of the equator, but to a port associated with a federal prison.

Today’s “Fraud of the Day” is based on an article entitled, “Rockland man pleads guilty to health care fraud, embezzlement,” published by Portland Press-Herald on December 11, 2018.

A Rockland man pleaded guilty Tuesday to health care fraud and embezzlement from a health care benefit program, according to U.S. Attorney Halsey B. Frank.

Michael A. Morrison, 42, entered his plea in U.S. District Court in Portland.

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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.