Oh My Aching Back

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Medicare does not cover the costs of massage therapy; however, it does pay for physical therapy when deemed medically necessary. The operator of several Los Angeles County rehabilitation clinics tried to skirt around Medicare’s explicit rules in this area by claiming his patients had received physical therapy services, when in fact they had not.

The operator of the three medical clinics and eight co-conspirators participated in a scam where millions of dollars in bogus claims were submitted to Medicare indicating that patients had received physical therapy treatments. (They allegedly received massage and acupuncture treatments, which are against the rules.)

As a result of the false claims, the ringleader and his associates received approximately $2.9 million in reimbursements from Medicare over four-and-a-half years. Supposedly, the clinic operator kept $1.6 million for himself. (That amount would certainly pay for a bunch of massages and acupuncture treatments.)

The eight co-conspirators have already pleaded guilty to their role in the deceptive scam. (I bet their testimony was key to catching the mastermind behind the scheme.) A jury eventually convicted the ringleader of 19 felonies including healthcare fraud, making illegal kickbacks and identity theft.

At sentencing, this man faces between two and 129 years in prison for his illegal acts. (It looks like he is also facing a lot of kinks in his back and neck as a result of sleeping on an uncomfortable prison cell bunk for the next couple of decades.) It’s hard to say what this fraudster’s final punishment will be, but I doubt he’ll be getting a back massage or acupuncture treatments to relieve the stress he is about to experience for some time to come.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Brea man convicted of multi-million dollar Medicare fraud,” published by Orange County Register on October 24, 2016.

SANTA ANA – A Brea man faces decades behind bars after being convicted of using his rehabilitation clinics to submit millions of dollars in false Medicare claims.

A jury at the U.S. District Courthouse on Wednesday convicted Simon Hong, 54, of 19 felonies, including those for healthcare fraud, making illegal kickbacks and identity theft.

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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.