Clear Line of Sight

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Binary data with the word IDENTITY appears in the shadow of a hand. Concept for digital crime. Blue toned image.

Opticians are eye wear professionals who help customers find the perfect pair of prescription eyeglasses and ensure they fit properly. There is a set of specific knowledge and skills that one must possess to become an Optician. Being skilled in identity theft fraud is not one of those.

In 2016, an entrepreneurial Optician from Lawrenceville, Ga., opened up a business to provide ophthalmological services in New Orleans. Pay close attention to this important detail – his business was located in the same place as another medical clinic that had previously provided the same services.

Over four months, the owner used the name of the previous business to submit medical services claims to Medicare and other health benefit programs. (Why would he do that, you ask?) He wanted to use the National Provider Identifier of a physician who previously worked for the other business. (I’m guessing he didn’t have his own.) The claims submitted by the business owner made it appear as if the physician who worked for the previous provider also performed medical services at the current place of business.

As a result of the fraudulent claims submitted by the dishonest Optician, Medicare and other health care benefit programs issued checks to the previous business and the physician whose National Provider Identifier was illegally used. The Optician deposited those ill-gotten checks totaling $20,669.67 into his bank account. (Of course he did. That’s what fraudsters do.)

The Federal Bureau of Investigation, Department of Health and Human Services, and the Louisiana Attorney General’s Office’s Medicaid Fraud Control Unit had a clear line of sight into what the unscrupulous Optician was up to. Their joint investigation ultimately led to an identity theft conviction for the fraudster from Lawrenceville.

The 56-year-old received a sentence of three years’ probation, with the first 45 days served in home confinement. He also agreed to pay full restitution to the Medicare and Medicaid healthcare programs. (Here’s hoping he now clearly sees how his illegal actions have impacted his victims.)

Today’s Fraud of the Day comes from an article, “Georgia Optician Sentenced In Identity Theft Case,” posted by AllOnGeorgia.com on January 27, 2020.

U.S. Attorney Peter G. Strasser announced that JOHN ANTHONY MARSH, age 56, a resident of Lawrenceville, Georgia was sentenced on January 22, 2020 by U.S. District Judge Martin L.C. Feldman to three years’ probation, with a condition that the first 45 days be served on home confinement, in connection with his guilty plea to identity theft.  In addition, MARSH agreed to pay restitution to the Medicare and Medicaid programs.

According to court documents, in 2016, MARSH opened a business in New Orleans called Magazine Medical Group & Associates, LLC (“Magazine Medical”) that provided ophthalmological services.  MARSH opened Magazine Medical at the same location as another medical clinic that had provided ophthalmological services, Business 1.  Between June 2016 and September 2016, MARSH used Business 1’s name when submitting claims for medical services to Medicare and other health care benefit programs to make it appear is those purported medical services were performed at Business 1.

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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.