Groupthink

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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

Fraudsters can be said to suffer from “Groupthink,” a way of thinking where a group of individuals reaches a conclusion that is thought to be correct, whether it is or not. Fraudsters tend to think that they deserve to receive government benefits when they really don’t. In their own mind, they justify this dysfunctional line of thinking and commit criminal acts that steal from others. A Cheyenne, Wyoming psychologist and his wife were part of the erroneous opinion that they deserved to collect more money than they deserved from the Wyoming Medicaid program. They stole $6.2 million from the government health program in a healthcare fraud billing scam that targeted patients who supposedly received group therapy.

Over nearly five years, the married couple falsely billed Medicaid for beneficiaries who supposedly visited their psychological practice in Cheyenne. The husband, who was a licensed Ph.D. psychologist and directed mental health services at the Wyoming practice, purportedly saw developmentally disabled Medicaid beneficiaries. His wife submitted bills to the Wyoming Medicaid program, while also managing the business and its staff. (She filed claims worth $6.2 million citing alleged group therapy, even though some beneficiaries were not participating in any group therapy.)

When the state program audited the couple and their business, they didn’t have proper documentation to support their group therapy claims. (So, they ordered an employee to create backdated treatment plans. Certainly, a common practice for fraudsters who buy into the erroneous idea that they deserve things, benefits, or that they don’t.) The couple submitted the fabricated treatment plans to the Wyoming Medicaid program to justify their erroneous bills and to hide their healthcare fraud billing scheme. (Needless to say, they didn’t buy it.)

The 68-year-old husband and his 63-year-old wife each pleaded guilty to one count of healthcare fraud. In exchange for their guilty plea, other charges of making false statements and money laundering were dropped. The couple was sentenced to 37 months in federal prison for fraudulently billing Wyoming Medicaid for mental health services that were never provided. Other consequences for their bad behavior included the forfeiture of more than $750,000 in assets such as cash, retirement accounts, vehicles and a residence linked to the fraud. They must also pay more than $6.2 million in restitution to the Wyoming Department of Health and the U.S. Department of Health and Human Services.

Today’s fraud case is a good example of why it’s not always a good idea to go along with the group. (While fraudsters widely conclude that they will get away with stealing taxpayer dollars, their group mentality is flawed.) Ironically, they are bound for prison where they will become a part of an even wider group of flawed thinkers. (Let’s hope that they can be rehabilitated and recognize that fraudster groupthink should be avoided.)

Today’s “Fraud of the Day” is based on an article entitled, “Cheyenne Couple Gets 37 Months for Health Care Fraud,” posted on KGAB.com on December 4, 2018.

A Cheyenne psychologist and his wife have been sentenced to 37 months in federal prison for making false statements as part of a scheme to fraudulently bill Wyoming Medicaid for mental health services, which were never provided.

John Robert Sink, Jr., 68, and Diane Marie Sink, 63, were indicted in March 2018 by a federal grand jury for health care fraud, making false statements and money laundering.

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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.