Hindsight is 20-20


It’s usually easy to see the difference between doing something the wrong way vs. the right way after the fact. (That’s called hindsight.) An article posted on TulsaWorld.com tells about an optometrist who knew the difference between right and wrong, but made a very unwise decision to submit fake bills to Medicare and Medicaid for services that were not provided. (Let’s just say that the government and the optometrist didn’t exactly see eye to eye on the amount that was disbursed.)

The story states that for more than 10 years, the optometrist claimed he worked more hours that he actually did. Apparently, he billed Medicare for more than 12 hours a day on 387 occasions and more than 24 hours a day on 124 occasions. (Maybe he was just really bad at math.) One of the bills claimed he worked more than 68 hours in one day. (OK, maybe not.) He also billed Oklahoma’s state Medicaid program for more than 12 hours a day on 96 occasions.The bogus bills cost Medicare more than $1.3 million, while the state program lost more than $150,000 as a result of his criminal actions.

The government filed a lawsuit against the man, seeking more than $13 million or three times the damages including additional penalties. (The False Claims Act allows the federal government to recover triple the actual amount of damages for any false claims paid by Medicare and Medicaid.)

The 63-year-old optometrist denied any wrongdoing; however, he agreed to pay $150,000 to settle the federal lawsuit. There was no mention as to how the settlement would be divided between the federal and state programs.

Everyone knows that choices have consequences, some good and some bad. Mistakes also can provide a learning opportunity for those who choose unwisely. In this particular case, it’s pretty clear that the doctor’s choice to submit fraudulent bills was a bad choice. (It also appears that he got off easy.) Let’s hope this fraudster has learned a lesson and can now see more clearly as to how his actions have impacted his victims.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Claremont Optometrist Robert Charles Duke to Pay $150,000 in Medicaid, Medicare Fraud Case,” written by Curtis Killman and posted on TulsaWorld.com on January 28, 2015.

A Claremore optometrist has agreed to pay $150,000 to settle a federal lawsuit that alleged false Medicaid and Medicare billing dating back 10 years, prosecutors said Thursday.

Robert Charles Duke, 63, agreed to the settlement amount after state and federal prosecutors sued him and his Catoosa business, claiming the two had received more than $1 million in payments after submitting false and inflated patient billings over the years.

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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.