Dr. Linh Cao Nguyen owned and operated what he claimed to be a mobile multi-specialty medical practice that could treat patients in their homes and living facilities. Despite his claim, it was really a multi-million dollar fraud on wheels. According to the Justice Department, Nguyen routinely sent out nonphysician practitioners (NPP) to care for patients in their homes. A NPP is usually a nurse practitioner or clinical nurse specialist who practices in collaboration with or under the supervision of a physician. Not necessarily a big difference in patient care, but definitely a big difference when it comes to billing Medicare. Knowing this, and despite it, Nguyen billed Medicare those services rendered by a NPP to his and other physicians’ National Provider Identifier (NPI), thus receiving the higher rate of a physician.
Evidence of knowledge in wrongdoing and a willful mindset is the difference between an overpayment case and a criminal case. Nguyen had been previously told by auditors that he was improperly billing for NPP services at the physician level. Which makes him a fraudster, not a distracted doctor. One specific allegation was that a third-party biller told Nguyen that he needed to be physically present to claim services rendered. To which Dr. Nguyen’s response was “what Medicare doesn’t know won’t hurt them.” But it does and it also hurts the U.S. taxpayer.
Nguyen regularly referred to his billing scheme as his “secret sauce” and that by merely signing his NPP’s records he could make money. To further his scheme, Nguyen employed staff from Vietnam to sign his name to medical records to make it appear as though Nguyen had personally rendered the service. Court records show that Nguyen referred to his staff in Vietnam as his “secret weapon.”
Nguyen’s secrets, however, didn’t stop the Office of Inspector General. On October 25, 2024, Nguyen was sentenced to two years in prison for Medicare fraud.
Great job by the Department of Health and Human Services.
Today’s Fraud of The Day is based on article “Peoria doctor sentenced to prison for scamming insurances for nearly $4 million” published by KTAR News on October 25, 2024
A Peoria doctor was sentenced to two years in Tucson prison for health care fraud, according to the U.S. Attorney’s Office District of Arizona.Dr. Linh Cao Nguyen, 51, defrauded health care programs for years including, Medicare, TRICARE, AHCCCS, Blue Cross Blue Shield and UnitedHealthcare. Nguyen pleaded guilty to health care fraud on March 19, 2024.
Nguyen knowingly submitted thousands of fake billing claims and forged patient records in order to avoid being caught, according to authorities.Ngyuen would claim a medical doctor as the treating provider but in reality, another provider such as a nurse practitioner, social worker, unlicensed psychology intern or wound care nurse provided services.