Oh For the Love of Fraud!

Ok, I’ll admit it—that was an easy one. Maybe too easy. But I’m workshopping titles for an upcoming Frauddirected-research paper, and I always like to warm up with the lowest form of  wit. (I usually don’t go much higher than that.) I also happen to be workshopping subjects. The paper will be about fraud, generally, and a yet-to-be-decided fraudster from Texas, specifically. Without further ado, here are your candidates:

The first is D-town’s Jacques Roy, who has the business acumen of a young Frank Abagnale. Roy committed the largest health care scam in history. He tried to bilk CMS for $375 million by selling his doctor certification to nearly 500 home health companies. In his heyday, Roy held the record for most patients (roughly 11,000) and most beneficiaries certified for home health services. According to one report, Roy churned out thousands of phony Medicare claims by bribing the homeless with cash and groceries. The report also said that when Roy’s business manager recommended legal marketing strategies instead of fraud, Roy responded, “I’ve done enough marketing to know it’s b___sh__, and I don’t want to do it.” And do it he didn’t! With gusto, even. This guy was actually caught with a book titled “Hide You’re A$$et$ and Disappear: A Step by Step Guide to Vanishing Without A Trace.” He would be a great subject, if only the trial was over. He was arrested in 2012, his trial was set for 2014, then pushed to early 2015, then mid 2015, and still nothing.

The next potential candidate is the CEO of Riverside Memorial Hospital in Houston. Earnest Gibson III was arrested alongside his son and five others. They used the Partial Hospitalization Program to submit $158 million worth of Medicare claims over seven years; $46.2 million was paid out before they were caught. Together with a third man, Mohammed Khan, the Gibsons forged a plan that paid over three thousand dollars in cash to “patient recruiters.” Those recruiters used the money to pay off group-home owners. Other eligible patients were apparently lured with cigarettes, food, and coupons redeemable in Riverside’s on-campus “Country Store.” Papa Gibson received 45 years behind bars, his son, 20, and Kahn got 40. The case is complete, which means I should have more access to more information.

The final potential target is actually more of a phenomenon than an individual fraudster. Harris County (Houston) has 397 ambulance companies, of which, 333 are currently or have been subject to Medicare reviews due to billing irregularities or mistakes. Apparently many of these companies carry patients who are not debilitated, not headed to a hospital, and not suffering from a medical emergency. Confused? So are the “patients.” But follow the money. Harris county EMSs have received $500 million from Medicare over a six-year period. In 2009, Medicare paid Harris County EMSs $62 million and New York City EMSs $7 million. One Houston newspaper actually started following these vehicles to figure out who was inside. On one of many such occasions, they met a 23 year old who told the reporter that he was taken to a residential home where he was fed junk food and told to watch TV. He didn’t know why he goes, or why he is transported by ambulance, he just knows that his caretaker schedules a round trip six days a week. This is not a Houston-only problem, either. In 2013, Medicare’s billing contractor for Texas randomly sampled 100 EMS claims. They found an error rate of 80%! The topic is incredibly interesting, if only to show how simple it is to defraud public programs. Unfortunately, the problem is broad but diffuse. There would not be a good narrative to keep the paper organized.

So there you have it. If you have any suggestions, please feel free to respond to this post. Otherwise, I will take your silence as a vote of confidence for whomever I choose

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