Forceful Fraud

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47990606 - doctor and patient at the table. solution.

No one likes to be forced into doing something they don’t want to do. However, greed and selfishness can sometimes cause a powerful person to force others into helping carry out their fraudulent acts. An article published on NOLA.com details how the owner of three community mental health centers and two residential facilities took advantage of her patients and scammed Medicare out of $43.5 million.

According to the article, the owner acquired her victims through mental health facilities she owned and operated in Louisiana and Texas. (It’s difficult to defraud Medicare without billing eligible beneficiaries.)

The scam involved the submission of more than $258 million in Medicare claims. She accomplished the large volume of claims by forcing the patients at her residential apartments to use her health care center services regardless of whether they needed them or not. She also paid a recruiter to deliver patients to her hospitalization programs and directed her administrators to falsify records stating that the patients received treatment when in reality, they did not.

The 54-year-old pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks. She was sentenced to eight-and-a-half years in federal prison and will pay back $43.5 million in restitution. (Sounds like a pretty fair sentence to me; however, I wonder if Medicare will ever see the restitution.)

It looks like this fraudster has been rendered powerless. Her fraudulent acts have landed her in prison. Perhaps wearing the same outfit every day, being confined to a very small cell and having no contact with the outside world will help her to reflect upon her selfish and greedy actions.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Baton Rouge Woman Ordered to Pay Nearly $44 Million in Restitution for Medicare Fraud Scheme Involving Mentally Ill,” written by Emily Lane and published by NOLA.com on August 18, 2014.

The Baton Rouge owner of three mental health centers was sentenced Monday (Aug. 18) in U.S. District Court in downtown Baton Rouge to pay $43.5 million in restitution and serve 8-and-a-half years in federal prison for a Medicare fraud scheme.

Hoor Naz Jafri, 54, owned and operated two community mental health centers in Baton Rouge and one in Houston, a press release from U.S. Attorney Walt Green’s office says. Seventeen people who worked at the facilities in a variety of roles have also been indicted the fraudulent operation that stretched seven years. During that time, the center billed Medicare for hospital services for the mentally ill that were unnecessary or never provided.

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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.