Go Big or Go Home

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Calculator and stethoscope on paperwork

Most of the workers’ compensation fraud stories covered on FraudOfTheDay.com tend to involve small to medium-sized businesses who try to defraud state workers’ compensation programs or private insurers by underreporting payroll to avoid high insurance premiums. (Or they simply don’t provide workers’ compensation insurance to their employees, hoping that no one will be injured.) Today’s fraudster from San Antonio, Texas decided to go big and defraud the Federal Employees Compensation Act (FECA) program.

The FECA program provides compensation to federal civil service employees for any wages lost because of a job-related injury. The businessman in today’s fraud article, who owned and operated a physical therapy and rehabilitation company in San Antonio and Salt Lake City, Utah, carried out his workers’ compensation fraud scheme for more than four years. During that time, he billed the program for more than $8.4 million in services and received $6.3 million for his fraudulent claims.

When investigators delved into the details, they found that the owner was able to submit bills under a licensed physical therapist’s (PT) identity. (The PT obviously had no idea that their identity was being used to commit a crime.) The company owner used codes that indicated a qualified professional provided the services, when unlicensed technicians were the ones providing treatments. (Thankfully, it does not appear that anyone was injured.)

The 40-year-old businessman from San Antonio was convicted of healthcare fraud and aggravated identity theft for collecting more than $6.3 million in government benefits he did not deserve. Today’s fraudster faces up to 10 years in federal prison for the healthcare fraud convictions, up to 20 years for wire fraud and up to another two years for aggravated identity theft. (“Go big or go home” is a likely thought he may have had when plotting out his illegal healthcare fraud scheme. Except now, he may be headed to the Big House – a.k.a. prison – instead of his home when all is said and done.)

Today’s “Fraud of the Day” is based on an article, San Antonio business man convicted of health care fraud,” published by the Houston Chronicle on June 21, 2019.

A San Antonio businessman was convicted Friday of engaging in health care fraud, according to a press release from the office of the U.S. Attorney of the West District of Texas.

Rafael Enrique Rodriguez, 40, was convicted by a federal jury on six counts of health care fraud, five counts of wire fraud and one count of aggravated identity theft.

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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.