The Doctor Will See You Now

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17828534 - chairs in the hospital hallway. hospital interior

Doctor visits are expensive in terms of time and money. It’s not uncommon to arrive on time for an appointment, then be kept waiting for what seems like forever to only get a few minutes with a physician. According to a survey on how much time the average doctor actually spends with a patient, it’s somewhere between 13 and 16 minutes. A doctor who owned a pain clinic in Morristown, Tennessee committed healthcare fraud by seeing more patients than he could possibly take care of. (On average, he spent around one to two minutes with each of his patients. Sounds like this guy valued quantity over quality of care.)

Time is money. Especially when you’re trying to run a healthcare fraud scheme. (Fraudsters have to make hay while the sun shines. The goal is to make as much money as possible before getting caught.) For more than four-and-a-half years, the Morristown doctor received $733,000 from Medicare and TennCare, Tennessee’s Medicaid program. (He had a little assistance from his wife, who happened to supervise the employee who submitted the bills.)

 The couple devised a plan to see more patients than a physician could realistically see in a day. According to today’s fraud article, the doctor saw 40 to 60 Medicare or TennCare beneficiaries a day, who were seeking treatment for chronic pain. (Apparently, they’d line up and get one to two minutes with the doctor on average.)  A staff member would hand the doctor a completed prescription for opioid pain medication for his signature. And, the patient received a follow-up appointment for a month later. (Next in line!)

The doctor and his wife instructed staff members to submit their fraudulent claims to Medicare and TennCare for the services they did not receive. (Both government healthcare programs paid out around $733,000 to the clinic.)

The couple pleaded guilty to healthcare fraud. (He admitted to issuing thousands of opiate prescriptions that were outside of the scope of ordinary medical practice.) The 64-year-old doctor received three years in prison, while his 59-year-old wife received a 16-month sentence for her part in the scheme to defraud Medicare and Medicaid. The doctor was also ordered to pay back $730,000 in restitution.

The doctor and his wife may have originally had the intention to provide their patients with quality care, but somewhere along the way, they got greedy at the government’s expense. It is kind of ironic that it’s no longer the doctor giving orders, but the judicial system. (Now, look who’s going to have to wait.)

 Today’s “Fraud of the Day” is based on an article entitled, Morristown pain clinic owner, wife sentenced to federal prison terms,” posted on WATE.com on March 14, 2018.

MORRISTOWN, Tenn. (WATE) – A doctor who owned a Morristown pain clinic and his wife have been sentenced to federal prison terms for health care fraud involving prescription pain medication.

Dr. Abdelrahman Mohamed, 64, received a 36 month sentence. His wife, Cecilia Manacsa, 59, received a 16-month sentence. Mohamed was also required to pay $730,000 in restitution.

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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.