Fraud Dispenser

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69066886 - non-proprietary medicine prescription bottles and spilled pills abstract with stethoscope.

In 2017, the Centers for Disease Control and Prevention (CDC) states that the U.S. opioid prescribing rate was 58.7 per 100 people. The good news is that number translates into the lowest rate in more than a decade. (The bad news is that more than 191 million total opioid prescriptions were dispensed that year – an alarming number that reveals that more than half the U.S. is under the influence of narcotics.) Today’s fraudster, a former Hillsboro, Ohio doctor, contributed to the opioid crisis by overprescribing. He also committed workers’ compensation fraud by billing the Ohio Bureau of Workers’ Compensation (BWC) for services that were never provided.

The statistics mentioned above are of particular concern to the National Council on Compensation Insurance (NCCI) because injured workers are commonly prescribed opioids to calm their pain. NCCI states that “…injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the U.S. opioid prescribing rate.” (This suggests that the opioid epidemic directly affects workers’ compensation programs across the nation, whose goal is to get workers on their feet and back to work as soon as possible. That’s kind of hard to do if they are addicted to opioids.)

A joint investigation between the Ohio Board of Pharmacy, the Drug Enforcement Agency, the BWC’s Bureau of Criminal Investigation and Ohio’s State Medical Board began after reports of prescription abuse cropped up. (The physician purportedly prescribed controlled substances without meeting the minimum standards of patient care.)

Approximately two years later, a search warrant was presented to the Hillsboro Urgent Care, the location where the doctor was employed. (While patient records were seized at the time, no arrests were made.) It wasn’t long before investigators discovered the doctor was very generous in prescribing large quantities of medically unnecessary oxycodone to many of his patients. It was also determined that the physician billed the BWC for medical services that were never rendered. (Instead of treating patients with a legitimate plan of care, he became an addictive pain pill dispenser and charged the workers’ compensation system for care he didn’t provide.)

The 59-year-old former Hillsboro, Ohio physician was indicted on 29 felony counts – 14 counts of aggravated drug trafficking, 14 counts of illegal processing of drug documents and one count of workers compensation fraud. He pleaded guilty to only four counts of drug trafficking and one count of workers’ compensation fraud and was sentenced to one year for each of the five counts. The fraudster must also pay $12,060 in restitution to the BWC.

The doctor profiled in today’s article was not interested in improving his patients’ conditions, he just wanted to make some extra cash at the expense of vulnerable individuals who deserved and qualified for better care. Congratulations to the government agencies involved in the successful prosecution of this fraudster. Here’s hoping their efforts will continue to drive down the alarming statistics involved in the battle against opioid addiction.

 Today’s “Fraud of the Day” is based on an article entitled, Former Hillsboro doctor gets five years,” posted on wnewsj.com on May 25, 2018.

HILLSBORO — A former Hillsboro doctor was sentenced on Thursday to five years in prison after pleading guilty to drug trafficking charges and workers’ compensation fraud in Highland County Common Pleas Court.

Judge Rocky Coss handed down the sentence for Timothy Manuel, 59, of St. Louis, Mo., after Manuel pled guilty last month to four counts of aggravated trafficking in drugs and one count of workers’ compensation fraud.

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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.