Forging Ahead

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One of the most common schemes used to bilk money from Medicare involves the unnecessary supply of power wheelchairs and medical supply accessories. An article published by The Tyler Morning Telegraph profiles a health care supply company owner who bilked Medicare of more than $1.6 million through a similar scheme.

The article states that the owner of the health care supply company and several co-conspirators used illegally-obtained health information including the names, birthdates and Medicare numbers belonging to elderly people to order power wheelchairs and orthopedic kits containing braces, wraps, supports or heat pads. (As you can guess, they were not medically necessary, not prescribed by an authorized physician, nor needed by the beneficiaries.)

Over a period of two years, nearly 800 claims were submitted by the health care company with forged physician signatures. (They used the names and personal information of deceased beneficiaries.) Medicare reimbursed the woman’s company for $1.6 million as a result of the bogus claims requesting $3.4 million.

Prior to being arrested at a Houston airport, the woman had been a fugitive for several years after being indicted on charges for conspiracy to commit health care fraud, health care fraud, and aggravated identity theft.

The woman was sentenced to seven years and three months in prison. One of her co-conspirators was sentenced to six years in prison for conspiracy to commit health care fraud, health care fraud and money laundering. Another pleaded guilty to health care fraud and tax evasion and received a 15-year prison sentence. The two fraudsters cost Medicare an additional $18.5 million in losses.

Congratulations to the U.S. Department of Health and Human Services, the Office of the Inspector General, the Texas Office of the Attorney General – Medicaid Fraud Control Unit and the Federal Bureau of Investigation for forging ahead in their quest to prevent further loss. Although it took several years to track down the fugitive health care company owner, the collaborative effort succeeded in protecting taxpayers and providing Medicare beneficiaries with benefits they deserve.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Woman Sentenced to Jail for Healthcare Fraud,” published by The Tyler Morning Telegraph on February 3, 2015.

Vivian Yusuf, formerly of Port Harcourt, Nigeria, was sentenced on Jan. 2 to seven years and three months in prison for a health care fraud scheme in the Eastern District of Texas by U.S. District Judge Michael Schneider, according to U.S. Attorney John M. Bales.

The 44-year-old woman pleaded guilty on Sept. 17, 2014 to conspiracy to commit health care fraud. Through information provided in court From June 2007 to May 2009, Yusuf, who was the owner of Ivy Health Care Supply, along with Aghaegbuna ”Ike” Odelugo, James Reese and others devised a scheme to defraud Medicare through the marketing of power wheelchairs and accessories and ortho kits, which generally contained braces, wraps, supports, a heat lamp and/or heat pad. Additionally, as a part of the scheme, Yusuf and accomplices illegally obtained protected health information, which included names, dates of birth and Medicare numbers from elderly individuals. They supplied beneficiaries with kits and power wheelchairs that were not prescribed or even authorized by a physician nor wanted by the beneficiaries.

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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.