Doubly Deceptive

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The National Institute on Drug Abuse reports that more than 115 people in the United States die after overdosing on opioids each day. To counteract these horrifying statistics, methadone clinics have popped up all over the nation to treat people who are addicted to opioid-based drugs, like heroin or prescription painkillers. A Detroit, Michigan medical biller was doubly deceptive and committed Medicaid fraud by billing for psychotherapy services at the clinic where she worked and at the same time, billing on behalf of the doctors who provided the services. (There was just one problem, the services were never provided. She was just making all this up.)

Methadone clinics support those individuals who have a drug habit. It appears that the medical biller in today’s fraud article also had a habit. (Instead of a drug habit, she had a gambling habit.)

While working at the non-profit recovery clinic in Detroit, Michigan, the medical biller submitted claims to Medicaid for psychotherapy services patients supposedly sought there. Then, she turned around and billed on behalf of the doctors who supposedly provided psychotherapy services to the patients. (However, the patients never got the help because the doctors didn’t provide the services.)

The medical biller withdrew funds from the non-profit methadone clinic’s bank account at an ATM located in a Detroit casino, then she went gambling. (The article doesn’t say whether or not she won anything with the ill-gotten government funds, but my guess is she did not. The house always wins.)

Today’s fraudster may have gotten away with her ruse if it weren’t for a “data mining” claims query initiated by the Michigan Attorney General’s Health Care Fraud Division (HCFD). The data query flagged the methadone clinic where the medical biller worked as a provider with suspicious claims. Shortly thereafter, HCFD discovered that the medical biller was billing multiple entries for the same psychotherapy services provided to the clinic’s patients and for the doctors who were supposedly providing the therapy. (Analytics are great, right? It can reduce many human hours of effort down to minutes with a few algorithms.)

The 59-year-old woman was convicted of embezzlement, healthcare fraud and Medicaid fraud. She received a one-year jail sentence, plus five years of probation. The former medical biller must also pay $915,000 in restitution. (Is one year behind bars really enough to ensure that this woman, who stole from her employer and from those who are fighting drug addictions, won’t try this crime again when she gets out of prison?)

Today’s “Fraud of the Day” is based on an article entitled, Woman convicted for filing false medical claims, embezzling nearly $1 million from Detroit nonprofit,” posted on clickondetroit.com on May 31, 2018.

DETROIT – Lajuana Scott was sentenced Wednesday to one year in jail and five years on probation after she was convicted of three felony counts.

She was convicted of embezzlement from a nonprofit or charitable organization, health care fraud — false claim and Medicaid fraud – false claim. Court documents said the former clinic biller made Medicaid claims for services never performed and then used nonprofit money to gamble.

 

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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.