Doctor And Physical Therapist Guilty Of $30 Million Health Care Fraud Scheme

As the Allegiant Experts Blog has made clear for the
 past four years or so, there are many different ways to defraud Medicaid and
 Medicare – and none of them are admirable. If nothing else, our coverage of
 various health care fraud stories taking place all over North America has shown
 that both medical professionals and everyday people alike have come up with
 countless ways to team up and bilk our nation’s insurance programs of money
 that doesn’t belong to them.

They are just two of the latest perpetrators of health care fraud to join the ever-growing list of criminals who take advantage of those programs. As announced by the Southern District of New York branch of the United States Department of Justice today, Mathieu, a medical doctor and Behiry, a physical therapist, have each been found guilty of participating in a $30 million scheme to defraud Medicare and the New York State Medicaid Program. 

According to the DoJ report, both defendants were
 convicted following a six-week jury trial. The evidence, presented in the
 trial, showed that between 2007 and 2013, Mathieu posed as the owner of three
 of six medical clinics in Brooklyn, New York. During those years, he fraudulently
 billed Medicare and Medicaid upwards of $30 million for medical services and
 supplies that were medically unnecessary and/or not provided.

When at the clinics, he would sign numerous fraudulent
 medical charts. He would then issue referrals for expensive additional testing,
 occupational therapy and physical therapy. Among these referrals were sessions
 for physical therapy that were purportedly provided by Behiry. However, Mathieu
 saw no patients and simply created phony medical records for patients he
 pretended to treat.

Behiry pretended to provide physical therapy to many
 of the patients on Mathieu’s list of referrals and provided many of them with
 kickbacks for visiting the clinics. “In fact, Behiry was engaged in an empty
 charade designed to create the appearance of physical therapy, while almost no
 therapy was actually being provided to many patients,” says the report.

According to the DoJ, “Behiry completed thousands of
 fabricated reports, in which patients were described almost identically, and
 with little or no regard for actual medical conditions or needs. As with Mathieu, many of the charts were for
 patients whom Behiry and his team had not evaluated or provided therapy to at
 all.”

The fraudulent actions didn’t stop there. Mathieu
 went so far as writing unnecessary prescriptions for adult diapers and other
 incontinence products to the point of becoming “a top prescriber of adult
 diapers in the State of New York.” Even after his clinics closed down, he continued
 to write these unneeded prescriptions.

Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help your case. Our experts have been providing expert clinical services for nearly two decades and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.

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