Bad to the Bone

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31449392 - closeup of leg on bandage with crutches

One of the most basic requirements for any job – whether you are working your first part-time job as a teenager or are a week from retirement – is to show up. That is especially true for any orthopedic surgeons running their own medical practices. Today’s Fraud of the Day takes us to Utica, NY where one fraudulent orthopedic surgeon attempted to defraud workers’ compensation insurance but ended up losing his medical license instead for his workers’ compensation fraud scheme.

An investigation by the New York State Office of the Workers’ Compensation Fraud Inspector General found that the surgeon had been systematically submitting false bills for medical services rendered by a workers’ compensation medical provider to a wide variety of insurance entities. The investigation found that the surgeon was not in his Utica offices on more than 150 separate days between January 2015 and August 2017 while certifying he was. Instead, he was performing exams in Buffalo, New York, or was traveling out of the state or out of the country (even taking a springtime trip to Iceland).

In total, the workers’ compensation fraud scheme racked up a total of $87,000 in fraudulent payments. The scheme impacted multiple insurance bodies, including the State Insurance Fund, the County of Oneida and other insurance carriers, third-party administrators and self-insured entities.

“This former doctor enriched himself by practicing fraud instead of medicine,” said New York State Inspector General Catherine Leahy Scott in a press release issued by The New York State Office of the Workers’ Compensation Fraud Inspector General. “His criminal acts enabled him to travel extensively and vacation abroad while shunning the most basic requirements of his job.”

The surgeon was sentenced in Oneida County Court for his previous guilty plea to two counts of offering a false instrument for filing in the second degree. He was ordered to surrender his license to practice medicine and pay restitution for the full amount of his workers’ compensation fraud scheme – $87,000. He also received a one-year conditional discharge.

Today’s “Fraud of the Day” is based on an article entitled, New York Surgeon Sentenced for Nearly $87K Workers’ Comp Fraud Scheme,” posted on InsuranceJournal.com on June 8, 2018.

A central New York orthopedic surgeon has been sentenced for running an ongoing scheme that defrauded the workers’ compensation system by nearly $87,000.

Dr. Gregory B. Shankman, of Clinton, N.Y., was sentenced in Oneida County Court for his previous guilty plea to two counts of offering a false instrument for filing in the second degree. At sentencing, Shankman surrendered his license to practice medicine and paid full restitution of $86,896. He was sentenced to a one-year conditional discharge.

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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.