Two’s Company, Three’s a Crowd and Four’s a Fraud Scheme

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There’s a saying that ”two’s company, three’s a crowd.” This idiom usually is used when two people are seeking privacy and don’t want to be bothered. A press release published by the Department of Justice details the illegal activities of two company owners (who were probably trying to keep their scam private), an elderly doctor, and a hospital employee who ran a fraud scheme that bilked the Medicare program of $3 million. (Sounds like a great idea for a new television sitcom.)

The story states that the home health agency owners purchased stolen patient information from a hospital administrative employee then relied on the 86-year-old doctor, as well as other physicians, to sign false medical documents ordering home health services. The two home health agency owners then submitted the fraudulent claims to Medicare for reimbursement.

The 48-year-old female home health agency owner was convicted of one count of conspiracy to commit health care fraud and four counts of health care fraud. She was sentenced to more than 12 years in prison, three years of supervised release and was ordered to pay more than $3 million in restitution. (Now that sounds like appropriate punishment. Way to do your job, Judge!) The 43-year-old male home health agency owner pleaded guilty to conspiracy to commit health care fraud and was sentenced to one year and a day in prison. He also will serve three years of supervised release and will pay more than $1 million in restitution.

The senior doctor (who should have known better) pleaded guilty to one count of false statements relating to health care matters and was sentenced to time served, plus three years of supervised release. (He also will have to pony up nearly $100,000 in restitution.) The hospital employee pleaded guilty to conspiracy to disclose identifiable health information and was also sentenced to time served, three years of supervised release and more than $1.3 million in restitution.

It looks like at least two of the fraudsters will be paying for their illegal acts in bad company with their fellow inmates. Living conditions are likely to be pretty crowded in prison, and they’ll be wishing they had thought twice, thrice or even four times before committing their fraudulent acts.

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Owners of Two Houston-Area Home Health Care Companies, Doctor, and Hospital Employee Sentenced for Their Roles in $3 Million Medicare Fraud Scheme,” released by the Department of Justice on June 20, 2014.

Owners of two home health agencies, a doctor, and a hospital employee who sold patient information were all sentenced today for their roles in an $3 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Cardwell of the Justice Department’s Criminal Division, U.S. Attorney Kenneth Magidson for the Southern District of Texas, Special Agent in Charge Stephen L. Morris of the FBI’s Houston Field Office, Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

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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.