Kickbacks, Bribes and Narcotics, Oh My!

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Just as Dorothy was extremely worried about coming across wild animals such as lions, tigers and bears on their way to The Emerald City, the federal government must constantly be on the lookout for wild behavior by deceptive Medicare providers who stalk healthcare programs on a regular basis, just waiting to jump their prey. (Fraudsters are constantly looking to ravage the pot of money intended for beneficiaries who have paid into the program and truly deserve the associated benefits.) Just like the Wizard of Oz, the owner of two Detroit, Michigan area health clinics was hiding behind her two businesses, all the while using kickbacks, bribes and narcotics to carry out her $8.9M Medicare fraud scheme.

As we open up the curtains on today’s fraud case, you will see the owner of the two Detroit-based health clinics working together with several co-conspirators to falsify claims for home healthcare and other physician services. Her businesses grew as the owner offered to pay kickbacks and bribes in cash and write prescriptions for narcotics (like oxycodone) to Medicare beneficiaries in exchange for the use of their Medicare beneficiary numbers. Then, she falsely billed Medicare for services allegedly provided by the two clinics.

Over five years, the clinic owner and her co-conspirators worked hard to defraud the Medicare healthcare program through fake claims worth $8.9 million. Court evidence showed that the defendants falsified medical records and signed false documents to make it appear that the services claimed were provided. The services she billed for were usually medically unnecessary, provided by an unlicensed physician or not provided to the beneficiaries at all. (Keeping with the Wizard of Oz theme, you could say that she was the Wicked Witch of the Midwest.)

The 34-year-old clinic owner from Shelby Township pleaded guilty to one count of conspiracy to commit healthcare fraud and one count of healthcare fraud involving the submission of $8.6 million in false claims to Medicare. She was sentenced to 13 years in prison and ordered to pay $6.3 million in restitution along with her co-conspirators. (She must also forfeit the same amount of money.) After a separate four-day trial, a 47-year-old co-defendant from Detroit was convicted of healthcare fraud and will serve 11 years behind bars for her part in the scheme. Another co-conspirator from Oakland Township was sentenced to 42 months in prison while the fourth person involved in the scheme – a 39-year-old from Canton Township – received a prison sentence of 27 months.

Fortunately, the Medicare Fraud Strike Force whipped through this case like the twister that sent Dorothy’s house flying, shutting down the illegal operation. The perpetrators in this case most likely understand that they are not in Kansas, nor Detroit, anymore. And, after serving a few years behind bars, they’ll realize that there’s no place like home. (They should have thought about that before they committed Medicare fraud.)

Today’s “Fraud of the Day” is based on an article entitled, “Owner of Detroit health clinics gets 13 years for $8.9M in Medicare Fraud,” published by The Detroit News on November 14, 2018.

The owner of two Detroit health clinics was sentenced to 13 years in prison Wednesday for her role in an $8.6 million scheme involving fraudulent Medicare claims.

Jacklyn Price, 34, of Shelby Township, was sentenced by U.S. District Judge Robert Cleland, who also ordered Price to pay $6.3 million in restitution along with her co-conspirators and to forfeit the same amount, the U.S. Attorney’s Office said in a released statement.

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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.