Just Trying to Help Out

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Criminals like to use aliases to conceal their identity. (For example, Lester Joseph Gillis used the alias George Nelson, and was commonly referred to as “Baby Face Nelson.” Robert LeRoy Parker went by “Butch Cassidy.”) A Winston-Salem, North Carolina man used an alias to carry out more than $1 million in Medicaid fraud through a company he started with a co-conspirator in Jacksonville, Florida.

While today’s fraudster doesn’t quite rank in the same category as the criminals previously listed, the alias “Julian Winchester” was used to steal a considerable amount of money from the federal government and honest tax payers as well. (It’s not exactly a gangster style name, but good enough to cover up his real name, which was tied to a previous conviction for healthcare fraud.)

The Winston-Salem man and his co-conspirator from the same town, carried out the fraudulent healthcare scheme by going into business together. They started a company that provided medical care to Medicaid patients in Jacksonville, Florida. The co-conspirator, who is 30 years old, neglected to inform the Medicaid program that he was working with the man who went by an alias. (Well, that can’t be good.)

The 46-year-old man, who went by the name of “Julian Winchester” and had been previously convicted on healthcare fraud charges, was excluded from being a provider. (That means he was not allowed to bill any federal healthcare program for services. That’s why he needed the alias.)

That one small detail did not stop him from performing a variety of management duties for the Florida-based company. He hired and fired employees and routinely saw patients. (He also frequently travelled from his North Carolina home to Florida to “help out” with corporate operational responsibilities.)

The older partner also “helped” himself to the fraudulent company’s corporate credit card. He dined at restaurants and bought furniture and gas, among other things in North Carolina. (Keep in mind, the company did not have a corporate office in that state.) Apparently, the man’s immediate family also received more than $10,000 in direct withdrawals from the company’s business checking accounts. (It sounds like the whole family was “helping out.”)

The two Winston-Salem men, who conspired to illegally bill Medicaid through their healthcare business obtained more than $1.4 million in fraudulent reimbursements from the government program. The older man illegally received $1.2M for his part in the scam, while his younger co-conspirator obtained $211,311.

The two fraudsters pleaded guilty to conspiracy to commit more than $1 million in Medicaid fraud. They both face a maximum of five years in prison and a fine of up to $250,000. (The older fraudster was naïve to think that if he used an alias, the feds would never catch him. He assumed too much and now he has to deal with the repercussions incurred by both identities.)

Source:  Today’s “Fraud of the Day” is based on an article entitled, “Two Winston-Salem men convicted of committing more than $1 million in health care fraud,” published by Winston-Salem Journal on October 20, 2017.

Two Winston-Salem men were convicted this week on federal charges that they committed more than $1 million in health care fraud through a company they started in Jacksonville, Fla.

Shawn Thorpe, 30, and Ruben McLain, 46, pleaded guilty Tuesday in U.S. District Court in the Middle District of Florida to conspiracy to commit health care fraud. Each man faces a maximum prison sentence of five years and a fine of up to $250,000, according to a news release from the U.S. Attorney’s Office for the Middle District of Florida.

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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.