Poser

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26578311 - male nurse pushing stretcher gurney bed in hospital corridor with male & female doctors & nurses & senior female patient in a wheelchair

 Posers are individuals who pretend to be someone they are not. (Just check out your social media channel of choice to find a multitude of examples.) While most posers mean no harm and are just trying to fit in, today’s fraudster from Valley Stream, New York posed as the owner of two medical clinics in Brooklyn, New York to carry out a healthcare fraud scheme that robbed Medicare and the New York State Medicaid Program of $30 million.

New York State law requires that medical clinics be owned and operated by a medical professional. The man at the center of today’s case, was qualified to operate the clinic as a legitimate physician; however, he was posing as the owner. (The two medical offices were actually owned by a corrupt businessman who tried to sidestep government rules by hiring physicians to lie about their position within the company.)

To carry out his part of the $30 million ruse, the physician signed fraudulent documents that falsely verified he was the sole owner of the two clinics. He then presented them to financial institutions, Medicare, Medicaid and others, posing as someone he was not.

Over six years, the physician submitted many claims based on falsified medical charts to the Medicare and Medicaid programs, claiming he examined and treated hundreds of patients. The deceptive physician also billed for bogus prescriptions and medically unnecessary tests and supplies. (This illegal practice was common throughout the six medical clinics owned by the businessman that masterminded the illegal scheme.)

The physician in today’s article pleaded guilty to healthcare fraud and was sentenced to one year and a day in prison. According to the Department of Justice (DOJ), the 67-year-old from Valley Stream, New York, is also required to serve three years of supervised release and pay more than $1.8 million in restitution, while forfeiting $269,412 in illegal proceeds.

Today’s poser is the eighth defendant and the second doctor to be sentenced for their role in the $30 million healthcare fraud scheme. The corrupt businessman behind the scam got a decade in prison. His ex-wife, who was the owner of a medical supply company received a three-year prison sentence. Another physician received 18 months behind bars while a business partner got three years, a clinic office manager got one year and one day, and two business partners, who ran an ambulette company, were each sentenced to three years in jail. The DOJ press release states that three more co-defendants – a physical therapist, an occupational therapist and another doctor – are scheduled to go to trial this fall.

This poser’s disguise has been effectively exposed by the Federal Bureau of Investigation, Office of the Inspector General of the U.S. Department of Health and the New York State Office of the Medicaid Inspector General. It looks like he’ll be transitioning to another place where he will be required to fit in, except this time he won’t be posing. He’ll be wearing an orange jump suit – just like everyone else – and will learn how to act as a prisoner. (I’d say that’s an effective punishment for someone who tried to steal from vulnerable citizens, the government and honest taxpayers.)

Today’s “Fraud of the Day” is based on an article entitled, New York physician gets prison time for role in $30M billing scheme,” published by Becker’s Hospital Review on August 22, 2018.

A physician was sentenced to one year and a day in prison for participating in a $30 million scheme to defraud Medicare and the New York State Medicaid Program, according to the Department of Justice.

In January, Ewald Antoine, MD, pleaded guilty to healthcare fraud and conspiracy to commit healthcare fraud, mail fraud and wire fraud. According to the indictment, Dr. Antoine posed as the owner of two medical clinics in Brooklyn — Sunlight Medical and Psychiatric Services and Coney Island Medical Services — and falsely claimed he examined and treated hundreds of patients at the two clinics.

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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.