Texas woman convicted in $5.5M health care fraud scheme, DOJ says

A Texas woman was convicted Friday on six counts of health care fraud in connection with a $5.5 million federal workers’ compensation overbilling scheme, U.S. Justice Department officials said.

Melissa Sumerour, 48, of Lorena, was found guilty by a federal jury following a five-day trial, DOJ officials said in a statement.

Sumerour and co-defendant Latosha Morgan, 42, of Grand Prairie, billed the Department of Labor’s Office of Workers Compensation for more physical therapy work than was actually provided, officials said. Morgan has pleaded guilty and is scheduled for sentencing in March 2020.

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Both women worked for Dr. Les Benson, a physician who played pro football for the Dallas Cowboys in the 1970s, KWTX-TV of Waco reported in October 2018. That story said Benson had been indicted twice in connection with the case, which dates back to 2011, but Friday’s DOJ statement makes no mention of him so his current status was unclear.

An affidavit reviewed by KWTX in 2018 said Sumerour and Morgan worked as billing clerks for “Physician A,” whom sources told the station was Benson.

Criminal complaints stated that Physician A “incentivized Melissa Sumerour and Latosha Morgan to maximize billing by offering a bonus if their respective clinics billed over $50,000 in a week.”

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One complaint said Sumerour and Morgan “submitted and/or taught others to submit” false health care claims between January 2011 and March 2017, KWTX reported.

Since its creation in March 2007, the DOJ’s Medicare Fraud Strike Force has charged more than 4,200 defendants who had billed the Medicare program for nearly $19 billion, the DOJ statement said.