“Good cons are all based on the victim’s need, and the successful con artist is the one, I guess, who can exploit that…one of the great traits of confidence tricksters is the level that they flatter their victim.” – Alfred Molina, Actor and Musician
As a healthcare ethics keynote speaker, healthcare ethics consultant and book author, I ceased – a long time ago – to be surprised at the creative ways by which healthcare scam artists have stolen taxpayer money.
What is it?
What is it that makes stealing from our healthcare system so easy? Some blame the pandemic, others point to high employee turnover, and still more, blame investigators overwhelmed with opioid prosecutions. I am not inclined to agree.
A case in point has recently been concluded in Michigan. Where a so-called home healthcare company (Shring Home Care Inc.), was able to steal nearly $3 million from Medicare.
As reported by a release from the Department of Justice (September 27, 2023), Yogesh Pancholi, who is 43-years-old, was convicted for “conspiracy to commit health care and wire fraud, two counts of substantive health care fraud, two counts of money laundering, two counts of aggravated identity theft, and one count of witness tampering.”
He is a citizen of India. I bring up that point not because of his nationality but because under normal circumstances he would be excluded from billing the U.S. Healthcare System and specifically, Medicare.
Instead Pancholi “used the names, signatures, and personal identifying information of others to conceal his ownership of the company.” He conned Medicare by driving through a huge ethical loophole through the system and for a while, it was pretty darn successful.
After purchasing the company, Pancholi and his citizen buddies started to bill Medicare. The con allowed Pancholi to bill Medicare for services that the fake company never offered.
When the checks came into “the office,” Pancholi “transferred these funds through bank accounts belonging to shell corporations and eventually into his accounts in India.”
Caught and still in denial
As a healthcare ethics motivational speaker, healthcare ethics consultant and ethics book author and teacher, I cannot begin to relate how many “outraged denials” I have heard when a perpetrator of fraud gets caught, and is soon to face justice.
So, around the eve of his September trial, Pancholi faked a name and email accounts and went on an email writing spree to government agencies. Pancholi accused one of the alleged witnesses against him of numerous crimes and demanded the non-citizen should be expelled from the country. This was obviously done to silence the witness and the witness was innocent of the preposterous charges.
In January 2024, the perpetrator of this fraud could be facing a sentencing of 40 or more years.
Do I believe that as a non-citizen felt himself to be above U.S. law? Yes, I do. However, I also believe, as a healthcare ethics consultant, that this criminal conned everyone around him. Referring to the quote from above, “one of the great traits of confidence tricksters is the level that they flatter their victim.”
My guess is that Yogesh Pancholi a Millennial with more than a smattering of computer skills, believed himself to be the smartest guy in the room, if not the most arrogant. He undoubtedly “flattered” those around him into believing that the stupid Medicare healthcare system gave out money like a piggy bank.
What is it that makes it possible for even non-citizens to steal from the system. To be sure, the massive bureaucracy has little oversight or scant supervision. Not for a minute do I believe this scam is a “one-off.” For right now, quite sadly, others are planning or perpetrating similar cons.
The tired argument is in blaming a lack of Medicare inspectional services on the occurrence of these frauds. At the very minimum, the U.S. Government has the ability to subject every executive of companies such as Shring Home Care Inc. to mandatory, online ethics training. In that training, the consequences can be clearly defined.
Foreign citizen or not, Pancholi is soon looking at a jail cell in a federal prison. He may cry foul but as a taxpayer and a healthcare ethics expert, my feeling is forewarned is forearmed. Medicare is not a piggybank. Its purpose is to help Americans recover from catastrophic injury or illness.
When did it become so easy to defraud our government? When bookkeeping and bureaucracy replaced ethical common sense. An ethical mindset in needed to reinforce the idea that every choice has a consequence.
