Manipulating the System

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For patients that have isolated joint conditions with scar tissue, manipulation under anesthesia (MUA) is a procedure that improves range of motion with less pain. (Anesthesia helps to sedate patients, so they experience less muscle spasms and resistance while gaining range of motion.) A Chicago, Illinois physician was a master of manipulation. He used MUA to commit healthcare fraud and consequently manipulated insurance companies out of $783,000. He also committed identity theft during the process but, that was not all he was up to.

Today’s fraudster, an anesthesiologist and pain management specialist, owned an outpatient surgical center on North Michigan Avenue in Chicago. For approximately four years, the doctor directed his billing staff to submit bogus bills to patient insurance companies for MUA procedures that chiropractors employed by his company did not perform. In order to make these claims look legitimate, the doctor and other employees falsified patient records to support the fraudulent bills. He committed identity theft by using names, addresses and dates of birth for patients without their knowledge. He and a nurse fraudulently billed insurance companies for $3.5 million. Because the nurse who worked at the surgical center agreed to cooperate with prosecutors, her charges involving the case were dropped. (Wise decision on her part.)

But according to the fraud article, the physician has more trouble on the horizon. He and two other doctors are linked to multiple lawsuits involving the national opioid epidemic.

The physician was involved in operating an alleged “pill mill” out of a downtown office for four years. (Apparently, he was described as a “prolific prescriber” of controlled substances with more than 1.6 million doses prescribed out of his Riverside clinic.)

And, if that was not enough, he remains a currently unindicted co-conspirator in a federal case involving a Massachusetts-based drug company. The anesthesiologist was paid to cause the illegal distribution of a Fentanyl spray that was intended for cancer patients. He was also allegedly paid by the drug company to host bogus speaking engagements in exchange for prescribing the medication. (The drug company paid him $87,000 to prescribe the powerful drug to non-cancer patients. In fact, he was reportedly the top prescriber of the spray in the State of Illinois, accounting for 60 percent of the prescriptions dispensed.)

Today’s fraudster had his Illinois medical license suspended in 2016 and although he and other physicians tried to keep the illegal operation running, the clinic closed down a few months later in 2017. The 65-year-old anesthesiologist was convicted on six counts of federal healthcare fraud, three counts of making false statements concerning the delivery of healthcare services, and two counts of aggravated identity theft. He is facing up to 60 years in federal prison for healthcare fraud, up to fifteen years for making false statements, and four years for the identity theft charges. (Unfortunately, when sentenced, the physician will not be allowed to be under anesthesia, so he will most definitely feel the pain of remorse for manipulating the system.)

Today’s “Fraud of the Day” is based on an article entitled, “Former Riverside pain doc faces prison time,” published by Riverside-Brookfield Landmark on December 18, 2018.

A physician who operated an alleged “pill mill” out of a downtown Riverside office from 2013-16 faces the prospect of prison after a jury convicted him on all 11 counts in a federal medical insurance fraud case.

Dr. Paul C. Madison, 65, was convicted on six counts of health care fraud, three counts of making false statements in connection with the delivery of health care services and two counts of aggravated identity theft on Nov. 29 in U.S. District Court in Chicago.

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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.