Money Hungry

343

People who are “money hungry” will do just about anything to become rich. (Cue visions of luxurious vacations on sandy beaches and frolicking on yachts, while gold coins rain down.) Today’s fraud spotlight shines brightly on a former Montana optometrist who may or may not have had this particular vision in mind when he committed Medicaid fraud by repeatedly submitting insurance claims for excessive procedures and ailments his patients did not have.

For almost all of his Medicaid patients, the eye doctor, who worked at a Laurel, Montana Walmart, took a medical photograph of their eye during their eye exam. (Whether they needed it or not.) In many cases, he didn’t dilate the patient’s eye, which is apparently pretty important when trying to identify maladies of the retina.

Over two years, the eye doc submitted unnecessary insurance claims to Medicaid and Blue Cross Blue Shield. Approximately $2,100 of those claims were for unnecessary procedures. Another 23 claims were for patients that purportedly had a localized eye tumor, despite having no records to back up the claim. (Out of $4,300 in claims, he received $1,900 in reimbursements.) It’s also important to note that a separate doctor reviewed the cases and determined that 21 of the patients, which were children, did not show any signs of having the tumor.

While the former optometrist was originally charged with felonies for filing thousands of dollars to Medicaid and Blue Cross Blue Shield for unnecessary procedures and nonexistent conditions, the charges were subsequently reduced to misdemeanors. One count of making false claims to a public agency was dropped. The eye doctor from Montana saw the light and pleaded guilty to the misdemeanor charges surrounding Medicaid fraud and insurance fraud. He received a two-year deferred sentence on each count and probation during that period. (It sounds like he got off pretty easy.) He also has to pay $6,550 in fines and restitution.

Today’s “money hungry” fraudster definitely had a blind spot when it came to fraud. While this article doesn’t say how this criminal’s career will be impacted – whether he’ll be allowed to continue practicing optometry or be required to surrender his license – I’m envisioning a future that may not be so bright as the medical photographs he took.

 Today’s “Fraud of the Day” is based on an article entitled, Former Montana optometrist gets probation for submitting false insurance claims,” published by Billings Gazette on March 1, 2018.

A former Montana optometrist got probation for submitting false insurance claims while practicing in Laurel.

Gary Alfred White was sentenced on Feb. 22 for one count of Medicaid fraud and one count of theft by insurance fraud, both misdemeanors.

 

SHARE
Previous articleMisrepresentation
Next articleI Swear
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.