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.
Enter Paul J. Mathieu and Hatem Behiry.
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.
Mathieu also visited several of the clinics each week.
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.
Behiry also prepared numerous phony medical and billing records.
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.
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