Fraud investigation file Tshombe Anderson agreed to forfeit $375,000 seized from his residence, a 2015 Mercedes and his share of the $8,383,075 that was seized from 25 bank accounts. (Photo: Shutterstock)

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Tshombe Anderson, of Grand Prairie, Texas, has been sentenced by Chief U.S. District Judge Barbara M.G. Lynn to 120 months in federal prison. He has also been ordered to pay $26,572,458.93 in restitution for his role in a scheme he ran along with his family members from July 2011 to September 2015 to fraudulently obtain more than $26 million from the U.S. Department of Labor (DOL) Office of Worker’s Compensation Program (OWCP).

Anderson pleaded guilty in August 2017 to one count of conspiracy to commit health care fraud. Anderson agreed to forfeit $375,000 seized from his residence, a 2015 Mercedes, and his share of the $8,383,075 that was seized from 25 bank accounts. Anderson has been in custody since the time of his arrest in August 2015.

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In addition to Anderson, his sister, wife, and niece also were charged in the indictment returned in September 2015 and pleaded guilty to their roles in the scheme.

Fraudulent billing

“Anderson stole patient information from over 200 injured federal workers and then used the information to fraudulently bill OWCP, enriching himself and others with taxpayer dollars intended for the treatment of injured federal workers. We will continue to work with our law enforcement partners to safeguard all Department of Labor programs,” Steven Grell, special agent-in-charge of the Dallas Regional Office of the U.S. Department of Labor, Office of Inspector General, said in a statement.

According to plea documents in the case, Anderson worked as an attorney for Union Treatment Centers (UTC). Anderson and his wife opened a durable medical equipment company called Best First Administration (BFA).  BFA was formed, initially, to provide durable medical equipment to patients referred to BFA from UTC.  In July 2011, the Andersons disassociated from UTC.

Created companies to submit claims

In April 2013, Anderson agreed to open Union Medical Supplies and Equipment (UMSE).  In August 2013, Anderson opened Skycare Medical Supplies and Equipment (SMSE). Both companies were created to submit claims that were inappropriate to OWCP, according to prosecutors.

The same medical information that BFA had received from UTC was used and billed to the same universe of claimants for duplicate, unwanted durable medical equipment that was not medically necessary, using outdated medical information, according to the government.

Related: 6 signs of a false workers’ compensation claim

Anderson continued to do so despite knowing that the bills to the OWCP were for items that were not associated with claimants’ injuries and that claimants often were refusing or rejecting the durable medical equipment for which the OWCP had been billed.

Shell company

The government asserted that Anderson had access to the operating accounts for UMSE and routinely transferred large sums of cash from those accounts for his personal use or to launder through business accounts for a shell company called American Federal Union Claims Advocates, as well as accounts associated with his law office.

The total amount paid to OWCP for UMSE and SMSE was $26,572,458.93.

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Steven A. Meyerowitz, Esq., is the director of FC&S Legal, the editor-in-chief of the Insurance Coverage Law Report, and the founder and president of Meyerowitz Communications Inc. Email him at smeyerowitz@meyerowitzcommunications.com.