Fake It ‘Til You Make It

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20231116 - paper check from the united states treasury

A family who owned and operated a counseling business in Georgia successfully faked a vast amount of documents, then submitted them to Medicaid. Their fraudulent efforts paid off initially and they received more than $3 million from the government health care benefits program. (However, the judge and jury did not buy the owner’s defense, which redirected the blame to his employees.)

The counseling business was run by family members including the owner and Chief Executive Officer (CEO), his Chief Financial Officer (CFO) wife, a sister who served as office manager, and a sister-in-law who was the company’s human resources director. The CEO, a licensed professional counselor, carried out the scam by obtaining a Medicaid number. This allowed his company to participate in the health care program’s intensive family intervention program, which was designed to help poor children avoid losing their families and homes.

After search warrants were executed at the corporate office and a branch office, investigators discovered an extensive amount of information that showed the company had billed Medicaid for services that were never provided, gave illegal referrals and forged or faked documentation regarding their patients. (Further research revealed evidence including emails where one of the office’s employees was told to prepare fraudulent documentation, change session dates and create notes for sessions that didn’t actually occur.)

The judge and jury heard from dozens of witnesses that testified the family was honest and trustworthy. The defense attorney argued that the family business was set up by scheming employees. (But the jury, who deliberated more than seven hours, didn’t buy it.)

All defendants were acquitted except for the CEO, who was convicted of conspiracy. The judge sentenced him to five years in prison for his illegal acts. The employee who was ordered to falsify patient records, admitted her part in the fraud scheme, and was given a five-year probation sentence under the First Offender Act.

”Fake it ’til you make it” is a phrase that is commonly used to encourage those who lack the confidence needed to succeed. This confident business owner tried to fake the documentation necessary to defraud Medicaid and stole from the neediest children, but in the end, the justice system made sure that he didn’t ”make it.”

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”3 acquitted, 1 guilty in Medicaid fraud trial,” published by The Augusta Chronicle on November 6, 2016.

After hearing from dozens of witnesses and viewing enough records to cover the town in paper, the jury in this week’s Medicaid fraud trial acquitted the defendants of all charges except one – Carl ”Tony” Wardlaw was convicted of conspiracy.

The Richmond County Superior Court jury deliberated for more than seven hours before reaching the verdicts Saturday night. Judge J. Wade Padgett imposed the maximum sentence possible for Wardlaw, five years in prison

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.