Piggy Bank

11915058 - doctor writing prescription selective focus

Around the 15th century, dishes and pots were made out of a type of clay called “PYGG.” When people during that day and time were able to save an extra coin or two, they would drop it into their PYGG clay pot. Fast forward a few centuries to where PYGG pots were replaced with piggy banks, in all shapes and sizes. A Danville, Virginia doctor used two government health care programs to fill his own personal piggy bank. Instead of running a legitimate medical practice, he tried to bring home the bacon by committing healthcare fraud. (He did so by lying about the purported services he provided to his patients.)

The doctor, who owned and operated a family medical practice in Danville, not only defrauded Medicare and Medicaid, but additional private insurance companies. (Why not steal from all insurance companies?) He carried out his scheme by double billing patient visits under two different billing codes. Then, he covered up his deceit by recording false information on patient records to back up his bogus claims. (Who knows what medical conditions he concocted to collect the extra income.)

Because the Danville doctor billed for services he didn’t provide, the multiple healthcare programs overpaid more than $990,000. (And, as you might guess, he never reported that extra income on his tax returns. This man not only pigged out on undeserved healthcare payments but also added tax fraud to his scheme.)

Even after he was warned about his billing practices, he continued to defraud the insurance programs. Because the government thought this deceptive doc’s actions were pure hogwash, he was eventually sentenced on one count of healthcare fraud and one count of tax fraud. The 55-year-old fraudster was sentenced to two years in prison and ordered to pay $1,739,194 in addition to repaying $125,789 in investigative costs.

Some piggy banks have a rubber plug on the underside of the ceramic animal where the owner can access the coins kept within. Others don’t have the plug and must be broken to get the content out. Unfortunately for this doctor, who was hamming it up on the generosity of the federal government, now knows how good the government is at rooting out fraud. (The justice system broke the fraudster’s proverbial piggy bank and I’m guessing he is probably now wallowing in self-pity.)

 Today’s “Fraud of the Day” is based on an article entitled, Danville doctor sentenced to 2 years on healthcare fraud, ordered to pay $1.7 million,” posted on WSET.com on January 9, 2018.

DANVILLE, Va. (WSET) — A Danville doctor, who prosecutors said billed various insurers for services he never administered to patients, even after he was warned about the practice, was sentenced on healthcare fraud and tax evasion charges.

The U.S. Attorney announced Edwin L. Fuentes, 55, was sentenced to 24 months in prison.

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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.