Some Things Go Together

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12578261 - close-up portrait of a young female nurse

Some things go together like salt and pepper, peanut butter and jelly, night and day; and then there are fraudsters and their accomplices. An article published in the Star-Telegram describes how a doctor and nurse worked together to defraud Medicare of millions of dollars.

The story reports that a health care services company recruited Medicare beneficiaries and used accomplices to prepare fraudulent medical records to make it appear that the patients required home health services. The company collaborated with a registered nurse, who prepared the fraudulent medical records and a doctor, who certified unnecessary home visits and medical services. (Over a five-year period, the doctor billed $10 million in fraudulent claims for unnecessary home visits and medical services in exchange for kickbacks from the health care services company.)

The doctor and nurse were each convicted of one count of conspiracy to commit health care fraud. The physician also was convicted of three counts of healthcare fraud and four counts of making false statements regarding a health care benefit program. The 49-year-old nurse was sentenced to four years in federal prison for preparing fraudulent records, while the 60-year-old doctor received a federal prison sentence of 10 years. (These cases were part of a larger investigation that charged 91 doctors and nurses with Medicare fraud schemes in seven cities.)

Congratulations to the Medicare Strike Force for busting open this widespread scam. The justice system has made sure that the punishment meets the crime. (These two fraudsters are going to have to adapt to life in prison and some of the things that go together there including orange jump suits and jail cells.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Two Sentenced to Prison in Texas for Medicare Fraud,” published in the Star-Telegram on December 18, 2014.

An Arlington doctor and Grand Prairie nurse were sentenced to prison Wednesday for their plan to defraud the government of millions of dollars in unnecessary Medicare expenses, according to a news release from the U.S. attorney’s office.

Dr. Joseph Megwa, 60, was sentenced to 10 years in federal prison for making unnecessary home visits and ordering unnecessary medical services for Medicare beneficiaries from 2006 to 2011, according to the news release and Star-Telegram archives.

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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.