New Manager Needed

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Stethoscope on 100 dollar bills symbolizing financial surveillance

Despite the coronavirus pandemic, courts are still in session and hearing cases. One of the cases the Indiana Northern District Court will be handing down a sentence for involves Suzi Gawel, who stands accused of defrauding Medicaid of hundreds of thousands of dollars.

Gawel worked as an office manager at a company in Fort Wayne, where she sold medical equipment to clients across northern Indiana. Gawel’s work gave her access to privileged client information, which she stole to defraud Medicaid from January 2015 to October 2018. (I guess you could say she was excelling at one of her jobs, even if fraudulent. The average Medicaid fraud scam only goes undetected for about 16 months.)

The stolen data included patient’s names, addresses, date of births and Medicaid ID numbers. She used this information to submit reimbursement claims to Medicaid for unnecessary medical equipment. This equipment, which included oximetry devices and pneumatic compressors, were never ordered by physicians and therefore never delivered to patients. (These are expensive medical devices. Multiple reimbursements for these items could easily pay off a new car, a mortgage, or a beach house.)

More than 200 fraudulent reimbursement claims were issued on the behalf of patients. The money from the reimbursements was redirected into Gawel’s bank accounts. The fraud was discovered and investigated by the Indiana Attorney General’s Medicaid Fraud Control Unit, the Federal Bureau of Investigation Financial Crimes Task Force and the Organized Crime and Corruption Unit of the Indiana State Police. (This fraudster had the full weight of the U.S. Government working to put an end to her fraudulent schemes.)

This illegal reimbursement scheme cost Indiana Medicaid nearly $650,000. Gawel pleaded guilty earlier this year to charges of federal health care fraud and aggravated identity theft. Sentencing is set for Aug. 20 which may lead to Gawel serving prison time and paying more than $600,000 in restitution. (She’ll have to adapt from being behind a desk to behind the bars of a prison cell.)

In the meantime, Gawel has been released and will remain under supervision by the Pretrial Services Office pending sentencing. The court also ordered her to receive a psychiatric evaluation and to stay within the borders of northern Indiana.

Today’s Fraud of the Day comes from the article, “Hamilton woman convicted of federal fraud,” published by The Herald Republican on June 2, 2020.

FORT WAYNE — A Hamilton woman was convicted of federal health care fraud and aggravated identity theft Tuesday and will be sentenced in August.

Suzi Gawel, 57, pleaded guilty May 18. Tuesday, Indiana Northern District Court Judge Holly A. Brady signed the order and set sentencing for Aug. 20.

 

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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.