There are times in life where you have to stop and ask yourself:  “Is this worth the cost?” Perhaps you are purchasing a new car, or maybe you have decided to end a relationship for a new start.  Regardless, it’s always good to weigh the cost of taking action.  Fraudsters do the same thing:  which type of fraud gets me more money?  If I get caught, will a jumpsuit really be that bad?  According to an article in The Augusta Chronicle, one South Carolina resident misjudged the cost related to filing false reports to the government.

Efforts to crack down on Medicaid fraud in South Carolina have successfully put an end to a fraudster responsible for siphoning more than $1 million from state Medicaid programs.  A key figure in a management company responsible for operating six nursing homes in South Carolina was accused of submitting fraudulent cost reports to the state Medicaid program.  Two indictments charged the man with felony forgery and four indictments charged the man with misdemeanor medical assistance provider fraud. (In other words:  you said you’re costs were higher than they actually were to get a little extra cash.)

Under Medicaid regulations, nursing homes need to submit annual operational cost reports that allow the state program to pay for residents qualified under Medicaid.  The fraudster collected $1.02 million between 2009 and 2011 from false reports submitted on behalf of his six nursing homes.  A judge sentenced the man to 10 years in jail on the two forgery indictments, to run concurrently, but subsequently suspended the sentencing to five years’ probation..  For the Medicaid fraud indictments he was sentenced to three years in jail per offense, all suspended. He is expected to repay full restitution.  He’s already repaid $500,000. (Okay, so he’s almost halfway there.)

While he isn’t actually serving jail time, at least he’s on probation, suspended from Medicaid for his entire life and will need to pay back $1.02 million to the South Carolina Medicaid program. How’s that cost report, buddy?

  1. A trend analysis could have been performed, comparing other nursing homes in the area, to determine if the costs in the fraudster’s case was reasonable. An actual site visit (unannounced) could also have been performed.

Post a Comment

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>