Cross-country Fraud Deal Gone Bad

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Healthcare benefit forms including: enrollment forms and applications, stethoscope, calculator. Affordable healthcare remains an important topic around the world!

The illegal sale of controlled substances can be linked directly to the prescription drug epidemic the nation is currently facing. While prescription pain medicines are supposed to be carefully prescribed and regulated, mismanagement by healthcare professionals can easily go unnoticed, especially when they enlist someone outside of the healthcare profession to help them commit a crime. The girlfriend of a Pittsburgh, Pa. doctor pleaded guilty to conspiracy to illegally distribute oxycodone, commit health care fraud, commit money laundering, and theft of public money. (That’s quite a rap sheet. Some people will do anything for love.)

Marcia Arthurs admitted to conspiring to illegally distribute oxycodone, commit health care fraud, and laundering the money from the sale of oxycodone alongside her boyfriend and co-defendant, Paul Michael Hoover. (Marcia, Marcia, Marcia. What were you thinking?) Their healthcare fraud scheme lasted from March 26, 2015 to June 22, 2018. (Sadly, they successfully contributed to hundreds of people’s drug addictions for a little over three years.)

Hoover and Arthurs traveled from California to Pennsylvania for a few days at a time to manage their cross-country drug operation. Hoover would write the illegal oxycodone prescriptions in exchange for cash and Arthurs would manage the money they received. (Sounds like it was a match made in Fraud Heaven.) 

In addition to operating the pill mill, the couple received orders for oxycodone from Pittsburgh residents while residing in California. Arthurs and Hoover submitted preauthorization forms for oxycodone to Medicare and Medicaid as legitimate prescriptions. The dishonest couple used the oxycodone that the government healthcare programs paid for to sell to the buyers from Pennsylvania. (It’s definitely not a good idea to illegally sell illegally obtained drugs.)

The California couple also attempted to launder the proceeds from their ongoing drug operation. (There are many layers to this scheme that need to be unpacked. First they fraudulently obtain the controlled substance by defrauding healthcare programs. Then they sell it in a cross-country drug operation. Finally, they attempt to launder the funds from the scheme and get caught.)

To add to the list of crimes committed, Arthurs made false claims to the Social Security Administration about her living arrangements with Hoover and her total annual income. (You can’t exactly report drug dealer as your occupation on a government form.) This allowed her to fraudulently obtain $48,617.76 in Supplemental Security Income benefits.

Hoovers was previously sentenced to eleven years and four months in prison. He must also pay restitution to Medicare, Medicaid, and the Social Security Administration totaling $406,760.75.

Arthurs was sentenced to five years and three months in prison for participating in the healthcare fraud scheme. (I wonder if the relationship will hold up in prison.) She was ordered to pay restitution to the Social Security Administration totaling $48,617.00. Additionally, Arthurs must forfeit approximately $1.2 million in U.S. currency, gold, silver, and real estate. 

Report suspected healthcare fraud by contacting the Department of Health and Human Services’ Office of Inspector General hotline at (800) 447-8477 or through their online form.

Today’s Fraud of the Day comes from a Department of Justice press release, “Ex-Doctor’s Girlfriend Sentenced in Scheme to Illegally Distribute Oxycodone and Defraud Medicare and Medicaid,” on September 14, 2020.

PITTSBURGH – The girlfriend of a former Pennsylvania-licensed physician has been sentenced in federal court to a total of 63 months’ imprisonment on her conviction for conspiracy to illegally distribute oxycodone, conspiracy to commit health care fraud, conspiracy to commit money laundering, and theft of public money, United States Attorney Scott W. Brady announced today.

On September 14, 2019, Chief Judge Mark R. Hornak imposed the sentence on Marcia Ramsier Arthurs, age 62, formerly of Novato, California. Judge Hornak further ordered Arthurs to pay restitution to the Social Security Administration totaling $48,617.00, and to forfeit any interest she had in assets totaling approximately $1.2 million in U.S. currency, gold, silver, and real property.

 

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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.