Needs vs. Wants

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17206644 - closeup of a medicare insurance enrollment form

There is a definite difference between needs and wants. Needs are things required for living like food, shelter, water, or healthcare. Wants are desires for things or services that are not necessary, but what we’d like to have. Some people need opioids to legitimately fight pain that cannot be controlled by any other medication. Deceitful individuals desire opioids because they know they can make a lot of money selling them to individuals who are addicted and can’t get the drug legitimately. (It’s a vicious cycle.)

The former owner of an Uptown Chicago neighborhood medical clinic falls into the latter classification. He’s in trouble for Medicare fraud because he sold opioids to “patients” who intended to resell the drugs, not to people who really needed the pills. Then he stuck Medicare with the bill. (So, basically, he was a cog in a giant wheel that kept the opioid epidemic prospering.)

The 68-year old medical clinic owner from Lincolnwood partnered with a clinic physician to sell oxycodone, hydrocodone and other medications to patients who had no medical need for the prescriptions. The clinic owner worked with “crew leaders” to organize large groups of individuals to visit the clinic to see the physician. (Apparently, the doctor met with up to 70 patients a day, sometimes seeing two people at a time.) The clinic owner was often accompanied by a “crew leader” who told the doctor which prescriptions to write. For every bogus prescription written, the “patients” would pay the medical clinic owner and the physician up to $200. (There were times when the physician was directed to write prescriptions for people who were not seen. Then there were other times when the medical director would grab the doc’s prescription pad and dole out orders himself.)

This illegal pill mill was lucrative. Over 13 months, the two men raked in more than $584,000 from the illegal sales. The clinic director kept about $300,000 of the take. During that time, it is estimated that more than two kilograms of oxycodone, nearly 600,000 hydrocodone pills and more than 190,000 Xanax pills were prescribed to people who didn’t need the drugs. (That’s atrocious.) At the same time, Medicare reimbursed the clinic for the illegal office visits, paying out more than $350,000 to a joint bank account that the clinic director and doc agreed to split. (That’s enough money to take care of all their needs AND wants.)

The clinic director was so successful with the scam, he thought he’d try something else at the same time. He offered to pay kickbacks to a Chicago doctor if they would certify a Medicare beneficiary for home healthcare, then refer the patient to today’s fraudster’s medical clinic. (That scam didn’t turn out so well.) The doctor solicited by the medical clinic operator was cooperating with law enforcement and recorded their conversations. (You could say the rest is history.)

The 68-year-old medical center director from Chicago, Illinois pleaded guilty to one count of conspiracy to knowingly dispense controlled substances outside of the usual course of professional practice and without a legitimate medical purpose. Because he was the mastermind of a Medicare fraud scheme, he’s facing up to two decades in prison and a fine of up to $1 million. The physician involved pleaded guilty to drug conspiracy charges and is awaiting sentencing. (My guess is that neither of these two perpetrators is going to get what they want, but I’m confident that the justice system will deliver exactly what they need.)

Today’s “Fraud of the Day” is based on an article entitled, “Uptown Medical Clinic Owner Illegally Sold Hundreds of Thousands of Opioid Pills,” posted on WTTW.com on December 12, 2018.

The former owner of an Uptown neighborhood medical clinic faces up to two decades in prison after admitting to selling hundreds of thousands of dollars’ worth of opioid pills to patients with false prescriptions who planned to resell the drugs.

Mohammed Shariff, 68, pleaded guilty before a federal judge in Chicago this week to one count of conspiracy to knowingly dispense controlled substances outside the usual course of professional practice and without a legitimate medical purpose. He faces up to 20 years in prison and a maximum fine of $1 million.

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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.