Paper Pusher

28

Paper pushers are generally referred to in a derogatory manner because their job requires a lot of repetitive and monotonous work. (Some fraudsters excel at being paper pushers and can make a lot of money by repeatedly filling out fraudulent insurance claim forms, resulting in government benefit checks they do not deserve.) An article published in Focus Daily News details how two men stole $3 million from the Medicare program by filling out fraudulent claim forms.

The article states that for approximately five years, a home health care agency owner recruited Medicare beneficiaries to bill for unnecessary home health services. Along with the home health agency nursing director and others, he then created false medical records that stated patients required home health services. Another co-conspirator, who happened to be a doctor, falsely certified that the patients needed the home health services qualifying them for reimbursement under the Medicare program.

The 60-year-old doctor and the 49-year-old nursing director were each convicted for committing health care fraud. They received prison sentences of 120 months and 48 months, respectively. The doctor was also convicted on three counts of health care fraud and four counts of making false statements related to a health care benefit program. (This was connected to all of the false Medicare claims for bogus home visits or house calls that were never made.) The 56-year-old home health agency owner pleaded guilty to conspiracy to commit health care fraud and is scheduled to be sentenced.

These fraudsters probably never thought about the consequences of their fraudulent paper pushing acts, if actually caught. It looks like the Medicare Strike Force decided to push back and punish these perpetrators for their criminal acts. (I’m guessing that these two fraudsters will adapt to prison easily because there will certainly be a lot of monotonous and repetitive tasks to perform while serving out their sentence.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Physician, Home Health Agency Nursing Director Sentenced in $3M Medicare Fraud Conspiracy,” published in Focus Daily News on December 26, 2014.

DALLAS—A physician and a home health agency manager were sentenced this week for their roles in a $3 million Medicare fraud conspiracy, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.

Joseph Megwa, M.D., 60, of Arlington, Texas, and Ebolose Eghobor, R.N., 49, of Grand Prairie, Texas, were sentenced today by U.S. District Judge Ed Knikeade to 120 months and 48 months respectively, in federal prison. In May 2014, Megwa and Eghobor were each convicted on one count of conspiracy to commit health care fraud. In addition, Mega was convicted on three counts of health care fraud and four counts of making false statements related to a health care benefit program based on his submission of false claims to Medicare for home visits or house calls to patients that he never actually made.

Read More

SHARE
Previous articleFraud Vortex
Next articleNickname for Fraudster
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.