Eyes and Ears on the Lookout

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Happy young woman and her cute son looking at doctor and listening to his recommendations

Prosecutors are cracking down on health care practitioners who defraud state Medicaid programs. Michigan Attorney General Dana Nessel is giving stern warnings to those who steal from the state program that provides health insurance for the poor and disabled.

“Those who think they can get away with health care fraud, take note: there are many eyes and ears out there on the lookout and you will be caught and held accountable,” Nessel said in a recent case involving a physician. “It’s not worth it.”

Sometimes fraudsters are not hard to spot because they get sloppy and don’t cover their tracks. Sometimes claims raise red flags.

In one of Nessel’s recent cases, a 56-year-old Farmington, Mich., doctor pleaded guilty to two felony charges of Medicaid fraud and one felony of placing false information in medical records.

Nessel’s investigators found that the doctor billed for procedures that were never performed. Specifically, she billed for “phantom and unnecessary” therapeutic injections and infusions.

Some of the dates of the procedures were for days that the doctor was out of the country. (One of those red flags.) Also, investigators found that she was billing for more services than could have possibly been completed. (It sounds like this was not a hard case for investigators to figure out.) The fraudster from Farmington is scheduled to be sentenced this month and faces at least four years behind bars.

Today’s Fraud of the Day comes from the article, “Farmington Hills doctor pleads guilty to Medicaid fraud,” published Jan. 14 in Hometown Life, a USA Today website.

A Farmington Hills doctor pinpointed by Michigan Attorney General Dana Nessel has pleaded guilty to Medicaid fraud.

Dr. Ban Mechael, 56, pleaded guilty earlier this month to two counts of Medicaid fraud involving false claims and one count of placing false information in medical records.

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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.