Powering Down Fraud

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The term ”powering down” generally means to turn something off by shutting down operations in a systematic way. KPIX, the San Francisco Bay CBS television affiliate, reports on a story involving the Federal Bureau of Investigation (FBI) and their recent success at ”powering down” a Medicare fraud scheme, which involved two California-based medical equipment supply company owners and more than 400 power wheelchairs.

The article states that a husband and wife, who owned the two companies, submitted more than $3.2 million in fraudulent claims to Medicare for power wheelchairs and other accessories between 2006 and 2011. They were paid $1.6 million by the benefits program. According to the story, the 51-year-old husband and the 45 year-old wife had several accomplices who helped to recruit patients and to fabricate phony prescriptions for power wheelchairs and other medical equipment. (You guessed it – the wheelchairs were not medically necessary and not wanted in most cases.)

Patients were recruited from several locations within San Francisco neighborhoods, including a fast food restaurant and a senior center. The husband and wife team paid a medical clinic doctor $100 per patient to write fake prescriptions and two other patient recruiters $100 and $50 respectively for each patient referral. The criminal team had a well-oiled fraud machine going. The doctor even took along a portable copier to make copies of patient Medicare cards prior to conducting sham examinations. (A doctor that makes house calls and carries her own copy machine for insurance processing – now that’s service!)

During a 13-day trial, the husband and wife, plus one patient recruiter, pleaded guilty to conspiring to commit health care fraud along with individual counts of fraud. Each count carries a possible maximum sentence of 10 years in prison. The couple was also found guilty of conspiracy to pay and receive kickbacks for the phony patient referrals. The maximum sentence for this charge is five years in prison.

Congratulations to the FBI on their ability to ”power down” this health care fraud scheme. This is another case that proves the government will not tolerate health care fraud.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Trio Convicted in San Francisco Federal Court of $1.6M Medicare Fraud,” published by KPIX, the San Francisco Bay Area CBS affiliate on December 6, 2013.

SAN FRANCISCO (CBS SF) — Two medical equipment supply company owners and an associate have been convicted in federal court in San Francisco of conspiring in a $1.6 million Medicare fraud concerning power wheelchairs.

The three defendants were convicted by a jury on Wednesday after a 13-day trial and will be sentenced on March 20 by U.S. District Judge Jeffrey White.

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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.