A Lack of Durability

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close up of word medicare block letter

Some healthcare fraud schemes are simple and involve a singular physician overcharging Medicare in an attempt to pocket reimbursements for a few patients. Other frauds, like today’s case, are more complex and involve a multitude of conspirators attempting to defraud many Medicare beneficiaries.

Jessica Jones, of Louisville, Colo., and Elizabeth Putulin, of Coconut Creek, Fla.,  have each agreed to plead guilty to one count of conspiracy to commit health care fraud for their roles in a multi-million dollar Medicare fraud scheme. (It’s nice that they cordially “agreed” after they were caught.)  

Jones and Putulin are accused of working with co-conspirator Juan Perez to fraudulently submit over $109 million in fraudulent claims to Medicare. The fraudulent claims were for durable medical equipment (DME) including arm, back, knee, and shoulder braces. (The claims themselves weren’t so durable.)

Together Jones, Putulin, and Perez allegedly established shell companies across more than a dozen states. These shell companies were registered as DME providers so they could submit fraudulent claims to Medicare. The shell companies listed Perez’s mother, wife, and yacht captain as corporate directors of the shell companies. (Why does every fraudster feel the need to involve their family, much less their yacht captain, in their schemes?)

They purportedly obtained Medicare patient data by purchasing it from foreign and domestic call centers. (It seems that everything is for sale.) Medicare beneficiaries would be offered DME at “little to no cost” if they provided the call centers with their data. Jones, Putulin, and Perez then used that data to submit fraudulent claims to Medicare. It was revealed that many claims were for deceased patients or were repeat claims for the same patient. (Did they think the government would not cross check the claims?)

Their claims were made without obtaining an order from a licensed healthcare professional for DME equipment. The patients who received DME, were charged more than 12 times the average price of what the DME was worth. However, the DME was never provided to the majority of beneficiaries resulting in fraudulent claims worth $7.5 million.

Jones and Putulin were responsible for taking complaints from Medicare beneficiaries who never received their DME equipment or beneficiaries who received equipment they did not want or need. They were also in charge of dodging calls from insurance companies who wanted the beneficiaries’ medical records and prescriber’s orders. (If dodging calls from people you don’t want to talk to makes you a fraudster, I may be facing prison time.) Perez, Jones and Putulin face up to 10 years in prison, three years of supervised release, and a fine of $250,000.

To report suspected Medicare fraud, call the Office of Inspector General’s national fraud hotline at 1-800-MEDICARE or fill out their online form.

Today’s Fraud of the Day comes from a Department of Justice press release, “Two Defendants Agree to Plead Guilty to Multi-Million Dollar Medicare Fraud Scheme,” on September 29, 2020.

BOSTON – A Colorado woman and a Florida woman have agreed to plead guilty in connection with a multi-million dollar Medicare fraud scheme.

Jessica Jones, 30, of Louisville Colo., and Elizabeth Putulin, 30, of Coconut Creek, Fla., were each charged by Information with one count of conspiracy to commit health care fraud. Plea hearings have not yet been scheduled by the Court.

 

 

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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.