Corporate Greed in Medicare

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Some people just can’t get enough money. That seems to be the case with the owner of a Tennessee-based durable medical equipment (DME) company who will spend nearly four years behind bars and forfeit $600,000 for her role in a Medicare fraud kickback scheme. (She and a co-conspirator illegally billed the federal program for more than $4 million.)

The woman, 71, of Camden, Tenn., was one of two healthcare executives in the Nashville area busted in the fraud scheme. She was the founder and CEO of CCC Medical Inc., which had five locations in Tennessee. Her co-conspirator, a man who is the former CEO of Comprehensive Pain Specialists, was convicted in March after a seven-day trial. (He has not yet been sentenced.) His company, CPS, had as many as 40 pain clinics across ten states before going out of business in 2018, according to The Nashville Tennessean. (As the U.S. attorney pointed out, this wealthy pair preyed on their city’s most vulnerable patients.).

The woman submitted $4.6 million in false Medicare claims between June 2011 and June 2017, and Medicare paid $2.6 million on those claims. She then paid $770,000 in illegal kickbacks to the pain clinic executive. (They covered up the kickback payments by filing false tax documents.) She paid him 60 percent of the Medicare proceeds in exchange for him directing his CPS employees and providers to send referrals to her company, CCC Medical Inc. (She couldn’t get customers on her own, so she resorted to fraud.)

Like most fraudsters, she apparently couldn’t contain her greed. In May 2015, she complained to her partner in crime that her referrals from CPS had been lower than expected. They adjusted their agreement so that she paid him $150,000 for the sham purchase of a shell company known as ProMed Solutions LLC. The U.S. Attorney’s Office said this was to induce him to continue driving CPS referrals to CCC Medical. She pleaded guilty in August. (Let’s hope these two don’t work with public health funds ever again).

Today’s Fraud of the Day is based on the article, “Tennessee healthcare exec sentenced to 3.5 years in prison for kickback scheme,” which was posted on www.fox.17com, on Aug. 29, 2019.

NASHVILLE, Tenn. (WZTV) — A Tennessee health care executive has been sentenced for her role in a $4.6 million Medicare kickback scheme involving durable medical equipment.

Brenda Montgomery, 71, of Camden was sentenced to 42 months in prison and must forfeit nearly $600,000.

 

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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.