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Top Five Healthcare Fraud Billing Cases

Fraud is widespread in most sectors including the U.S. healthcare system where medical extortions, scams, and health insurance deceit continue to be reported. The office of the Inspector General usually undertakes inquiries of such incidents for trial. For any successful conviction to occur, the presented evidence must be convincing. This paper intends to explore the latest five fraud cases that were probed by the Inspector General’s of the United States between 2018 and 2019.

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The first reported fraud case involved the Otolaryngologist Philip B. Klapper together with Patricia Klapper. In a press release of February 6, 2018, they wrongly billed a federal medical management plan for hearing aids and audiological services in Murray, Kentucky (U.S. Department of Justice Office of the Inspector General, 2020). The United States Department of Labour and attorney Russell M. Coleman announced a settlement of $2,791,758 to resolve the case (U.S. Department of Justice Office of the Inspector General, 2020). The charges erroneously implied that certified practitioners conducted the audiological assessments only for evidence to prove that he lacked legal qualifications. As a consequence, Klapper was restricted from engaging in any activity which pertains to the compensation act involving the federal workers.

Rao Desu, who owns a retail drugstore chain located in Warren, New Jersey, was implicated in the second scam. He was charged with conspiracy to defraud the IRS and four counts of helping in subscribing to fake tax returns (U.S. Department of Justice Office of the Inspector General, 2020). Rao possessed the property, together with Desai as the lead pharmacist. Between 2004 and 2013, they conspired to conceal their cash income from the IRS. Desai pleaded guilty to the conspiracy in 2014, while Desu denied the charges (Office of the Inspector General, 2020). Although they are likely to be imprisoned for five years and fined about $250 000 for the offense, the court is yet to pronounce itself on the matter.

The third case revolved around a conspiracy to defraud where Latosha Morgan and Melissa Sumer both from Texas were identified as the main suspects. The two engaged in a scheme to extract huge cash sums from the Department of Labour as a claim for the services they provided in physical therapy, drug screening, and report writing. They swindled about 5.9 million dollars as entitlements from employees’ benefits from January 2011 to March 2017. Until now, the criminal division that handles fraud cases is yet to initiate any action against the two perpetrators.

The fourth case released on February 7, 2019, is about Batten, a registered nurse who facilitated a prison officer (captain) to have sex with a convict in a correctional institution based in Folkston. She encouraged and covered frequent sexual encounters between Fussell (the officer) and the inmate (U.S. Department of Justice Office of the Inspector General, 2020). The case is currently being handled in a full trial where she faces a fifteen-year jail term if proven guilty.

The last case centered on the healthcare fraud and money laundering allegations involving the Team Work Ready clinic CEO, Eugene Rose, his wife, and the Vice President. Apart from being sentenced to 233 months in 2018, the CEO was forced to pay $14.5 million to the Department of Labour (U.S. Department of Justice Office of the Inspector General, 2020). The other two accused were imprisoned for ten years (wife) and twenty-five years (vice-president of the clinic), accordingly. (U.S. Department of Justice Office of the Inspector General, 2020). The justice department in the end succeeded in presenting a solid case that ensured the sentencing of the three for several months.

In summary, the five major recent instances of fraud reported by the Inspector General’s office have adequately conversed in detail. A look at the Inspector General’s website reveals how healthcare frauds are becoming prevalent in the U.S., especially in overbilling the government and insurance companies. However, the justice departments, including the Inspector General’s office, are currently working hard to introduce measures that will help in countering the increasing fraud cases.

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Reference

U.S. Department of Justice Office of the Inspector General. (2020). Criminal and civil cases. Web.

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