The U.S. Attorney’s Office for the Middle District of Louisiana announced the sentencing of Marvin Clifton, M.D., of Baton Rouge, Louisiana, after he was convicted of workers’ compensation fraud for allegedly submitting more than $500,000 in false claims to the federal Office of Workers’ Compensation Program.

Clifton, 71, was sentenced to 18 months in federal prison and two years of supervised release after his imprisonment. He was also ordered to pay a $50,000 fine and a $100 special assessment. Attorney information wasn’t available.

According to the U.S. Attorney’s Office, Clifton ran a medical practice in Baton Rouge that offered physical therapy. He is accused of falsely giving some of his patients medical benefits under the federal workers’ compensation program, which provides medical treatment, wage replacement benefits, vocational rehabilitation, and other benefits to workers who have experienced job-related illnesses or injuries.

Clifton allegedly defrauded the program by deliberately falsifying material facts about services he provided his patients. He reportedly directed his office managers to falsify medical bills claiming he had provided physical therapy to patients with workers’ comp coverage. The doctor sometimes had his managers bill for treatment on days his office was closed. Other times, he billed patients for longer treatment sessions than what had actually been provided, officials said.

Clifton is accused of submitting over $500,000 in falsified bills to the Office of Workers’ Compensation Program between January 2015 and January 2019. Through the alleged fraud scheme, he managed to obtain approximately $340,342 from the U.S. Department of Labor.

The case was investigated by the U.S. Department of Labor Office Office of Inspector General, the U.S. Postal Service Office of Inspector General, and the Federal Bureau of Investigation. It was prosecuted by Assistant U.S. Attorney Peter J. Smyczek.

“This office will continue to aggressively investigate and prosecute those who commit healthcare fraud,” U.S. Attorney Brandon J. Fremin said in a press release. “Cheating the federal Workers’ Compensation Program is not a victimless crime, as it jeopardizes healthcare resources and steals taxpayer money meant to treat federal workers with real injuries and illnesses.”

Workers’ compensation fraud occurs when someone knowingly makes a false, material statement in order to save money, obtain money, or otherwise obtain an undeserved benefit.

Medical care providers may commit workers’ comp fraud by working in conjunction with workers by helping them fake or exaggerate injuries. The worker is able to collect disability benefits and the medical care provider collects payment for medical services that aren’t necessary or may not have been performed.

Sometimes medical care providers may defraud workers, employers, and insurers without the knowledge of the worker by:

• Performing unnecessary testing in order to bill insurers.
• Providing unnecessary treatment in order to bill insurers.
• Billing both workers’ comp insurers and health insurers for the same services.
• Billing for treatment that was never performed.

Business owners suspected of workers’ compensation fraud should immediately contact an experienced attorney who can build a good defense and ensure the best possible outcome should the case go to trial.

South Florida Workers’ Comp Fraud Defense Attorney

Accused of workers’ compensation fraud? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced workers’ compensation fraud defense attorneys.

Source: 3.12.20 Baton Rouge doctor sentenced for making false statements relating to health care.pdf