Paper Pushers

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Paper pushers are usually associated with doing boring or unimportant work. Today, we take a look at two Houston-based physicians who took paper pushing to a whole new level in totally separate multimillion-dollar Medicare fraud schemes. They signed off on fraudulent paperwork that caused the government healthcare benefits program to pay out $27 million (a drop in the bucket when you compare it to the amount of money the Medicare Strike Force has recovered since 2007 – around $14 billion).

The first doctor mentioned in the Justice Department press release had help from two co-conspirators. The physician falsely certified medical orders, then one of the co-defendants who owned and operated a medical clinic in the Houston area and the other co-defendant sold those orders and other documents to home health agencies in the area. Other deceptive individuals within the home health agencies took those fake medical orders, completed fraudulent paperwork signed by the physician, then submitted them to Medicare for services that were not medically necessary nor provided. The physician and his co-conspirators caused Medicare to pay out about $17 million. (And, all those co-conspirators got a cut of the deal, I’m sure.)

The 65-year-old physician was sentenced to 25 years in prison plus three years of supervised release for Medicare fraud. He must also pay more than $26 million in restitution. The 62-year-old co-defendant who owned the medical clinic was sentenced to 30 years in prison. She must also pay more than $20 million in restitution and forfeit $250,000. The other co-conspirator is awaiting sentencing for her part in the Medicare fraud scheme.

The other physician, 78, was sentenced to 36 months in prison plus three years of supervised release. He was convicted of Medicare fraud for signing care plans and other medical documents that falsely certified and re-certified patients for home-health services. His criminal actions caused Medicare to pay out $10 million. He also ordered $2 million worth of unnecessary diagnostic tests. In addition to the three years in prison, the doctor must pay more than $1.8 million in restitution and forfeit $274,213.46.

While these paper pushers from Houston forced through $27 million in Medicare claims, it looks like they will be filed away in prison for some time to come. (It’s a sad predicament these older fraudsters find themselves in.) With the average U.S. life expectancy at 78 for men and 82 for women, the two physicians and the clinic owner may never be free again. (A very high price to pay for greed.)

Today’s “Fraud of the Day” is based on the Justice Department press release, Two South Texas Doctors Sentenced to Prison for Roles in Separate Multi-Million Dollar Medicare Fraud Schemes,” released on January 29, 2019.

Two Houston, Texas physicians were sentenced to 25 and three-year prison terms for their roles in separate schemes to defraud Medicare out of payments for medical services.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Dallas Region 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.