A Wrinkle in Fraud

54221462 - medical syringe in the doctor's hands on the patient's background.

Botox injections are usually associated with the prevention of wrinkles. The drug can also be used to prevent chronic migraines and muscle spasms associated with Multiple Sclerosis, plus provide relief from the discomfort of many other medical conditions. An article posted on NewsChannel9.com tells about a Tennessee doctor who netted nearly $7.5 million from Medicare by deceiving his patients through bogus Botox treatments.

The story states that for more than four years, the doctor purchased vials of Botox that were not U.S. Food and Drug Administration (FDA)-approved and billed Medicare for legitimate Botox injections he did not administer. He bought 254 vials of the non-approved drug, but billed the government program for 17,766 vials of the FDA-approved substance. (His deception enabled him to receive $7,482,968 in unearned Medicare reimbursements.)

The 44-year-old doctor pleaded guilty to receiving the misbranded Botox and to acting with the intent to defraud or mislead. He was sentenced to two years and four months in prison followed by one year of supervised release. The doctor also agreed to forfeit $6.765 million seized from several of his bank accounts, plus pay back another $717,000 in restitution. (Further research revealed the doctor spent about $140,000 of the fraudulent funds with car dealerships. I wonder what he got in return.)

While Botox can provide a welcome relief to patients who suffer from many different maladies, this doctor betrayed his patients’ trust and most likely did not deliver a cure. Because patients are at the mercy of their doctors when relying on the best possible treatment for their individual medical condition, this case is particularly concerning, especially for those patients who received injections of the non-FDA approved drug. (No doubt this doctor will age prematurely while serving out his time in jail. It looks like the government has put a wrinkle in his fraud plan and he’ll be forced to take a dose of his own bad medicine.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Cleveland Doctor Sentenced for Medicare Fraud,” posted on NewsChannel9.com on April 3, 2015.

A federal judge in Chattanooga has sentenced a doctor from McDonald, Tennessee to two years and four months in prison.

44-year-old Dr. Raymond Sean Brown of McDonald pleaded guilty back in November to defrauding Medicare – that is, using misbranded drugs with the intent to defraud.

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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.