Short-Sighted

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A person who is short-sighted doesn’t have much foresight into what might happen in any given situation. (You could say they are living in the moment without much regard to the future.) The owner of an eye clinic in Jasper, Georgia was short-sighted when it came to owning up to her million dollar healthcare fraud scheme that stole benefits from the Medicaid and Medicare programs. (She was lacking vision into how her actions impacted her victims.)

The eye clinic owner also operated another location in Calhoun, Georgia. For approximately two-and-a-half years, the owner of the two eye clinics submitted false claims to Medicaid and Medicare for optometry and ophthalmology services that were never provided to patients. Despite knowing that she and her business in Jasper were excluded from participating as a provider for the two government healthcare programs, she used her second business in Calhoun to bill for services that were never delivered.

The eye clinic owner sought victims through targeted advertisements to senior citizens and disabled populations in housing complexes and community centers. She offered on-site eye exams and prescription glasses for free to Medicare and Medicaid beneficiaries. (Just remember, if it sounds too good to be true, it probably is.)

The eye clinic owner hired two licensed optometrists, who often travelled with her, to provide the eye exams. After the routine procedures, she would bill for complex ophthalmological procedures that involved inserting medical devices into tear ducts to treat dry eye conditions. (Here’s one word to describe that – ouch.)

So, since the clinic owner was banned from billing the two government healthcare programs, she used the identities of her two optometrists repeatedly. According to today’s article, she billed one patient up to seven times on the same day, even though no procedures were ever performed. (Lucky for them. I wouldn’t wish having an eye duct plugged on my worst enemy. Sounds horribly painful.) In total, today’s fraudster submitted more than $1.2 million in insurance claims through Medicare and Medicaid for services that were never provided.

Following a trial by jury, the 41-year-old eye clinic owner was convicted of 29 counts of healthcare fraud for filing bogus claims with Medicare and the Georgia Medicaid program. Her sentencing date has not been set.

This Georgian was so short-sighted that she could not see the harm she was doing to her victims. (And, because she had previously been banned from participating in either government healthcare program as a provider, it looks like she never focused on cleaning up her act after disciplined the first time.) Let’s hope that this repeat offender gets a sentence that will enable her to see her blind spots – which happen to be selfishness and greed.

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, Eye care provider convicted of Medicare and Medicaid fraud,” released on January 16, 2018.

GAINESVILLE, Ga. – Matilda Lynn Prince has been convicted by a federal jury of twenty-nine counts of health care fraud for filing fraudulent claims with Medicare and the Georgia Medicaid program for optometry and ophthalmology services that were never provided to patients.

“Prince stole hundreds of thousands of dollars from the Medicare and Medicaid programs by submitting fraudulent claims for services that were not performed,” said U.S. Attorney Byung J. “BJay” Pak.  “Through our partnership with the Georgia Attorney General’s office, we will continue to fight the costly effects of healthcare fraud in this state that divert critical resources away from citizens who truly need these services.”

 

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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.