Speeding Away with Fraud

41074037 - doctor and businessman shaking hand in front of stethoscope

Imagine a raceway of fraudsters all lined up in their racecars attempting to get away with their crime of choice. The flagman readies the flag and with a wave; the speeding fraudsters are off? It’s a close call between identity theft and unemployment fraud, but with a surprising push of speed, Medicare fraud flies over the finish line in a motorized wheel chair. Ok, maybe that’s a little far-fetched, but in reality, an OCWeekly.com article details how one California doctor actually used motorized wheelchairs to commit Medicare fraud. Although he may not be speeding his way to jail, the slow and steady approach will get him there eventually.

While some doctors may try scamming the system by ordering unnecessary tests or drugs for patients, one California doctor took advantage of a company specializing in durable medical equipment (DME), ordering motorized wheel chairs for individuals who did not need them. (Maybe he was trying to start the next Medicare Fraud 500.) The $1.5 million scam, assisted by two co-conspirators, billed Medicare for the cost of filling the wheelchair prescriptions, the wheelchairs themselves and delivery. Court documents reveal the patients’ unwillingness to accept the unnecessary wheelchairs, though their attempts to reject delivery were unsuccessful. (Hello, did you order the power wheelchair? Well, we have delivery set for your home, and you are going to have sign for it and take it anyway.)

How could one doctor find enough patients to commit $1.5 million worth of Medicare fraud from power wheelchairs? The investigation documented statements by patients who claimed the doctor lured them to medical clinics where he promised they would receive free items, such vitamins and juice. (Wheelchairs were probably in the fine print. Come enjoy some free vitamins, juice and power wheelchairs that you will be forced to take home with you.) According the officials, the doctor received about $1 million of the stolen $1.5 million in kickbacks, for generating fresh patients for false billings. He and his co-conspirators face up to 10 years in prison and $250,000 in fines for each count. The doctor himself faces hefty fines as he was found guilty of one count of conspiracy to pay and receive kickbacks, one count of conspiracy to commit healthcare fraud and six substantive counts of healthcare fraud. (It’s ok – when he’s out of jail he can open his own wheelchair shop to help pay back what he stole.)

It looks like this fraudster hasn’t quite finished his fraud race yet – he will be taking a pit-stop in the court room to receive sentencing with his co-conspirators. After his final pit-stop, I’m sure it’ll be off to finish line, crossing into orange jumpsuits and lockdown. Better charge the wheelchair battery; you might not be riding the machine for a while.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Dr. Sri J. Wijegunaratne of Anaheim Guilty of Role in $1.5 Million Medicare Billing Fraud Scheme,” written by Matt Coker and published by the OCWeekly.com on April 30, 2013.

An Anaheim physician was recently convicted in federal court for his role in a $1.5 million Medicare fraud scheme, according to the U.S. Attorney’s office.

Dr. Sri J. Wijegunaratne, 58, was found guilty of one count of conspiracy to pay and receive kickbacks, another count of conspiracy to commit health care fraud and six substantive counts of health care fraud.

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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.