Worker Bees

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “N.J. couple avoid prison in $7M Medicaid fraud,” an article that ran on on February 18, 2016.

An Elizabeth couple, described by authorities as low-level but essential players in a fraud scheme, avoided prison time for their roles in a plan to bill Medicaid millions for home health care services that were never done or performed by unlicensed aides.

Nelson and Sonia Mesa were sentenced to three years probation, with Sonia Mesa receiving four months of home detention Thursday by U.S. District Judge Katherine Hayden. Federal prosecutors had sought prison sentences for both, or at least a minimum of six months of home confinement.

Authorities said the scheme cost Medicaid, the joint state and federal health care program for the poor, their children and the infirm, roughly $7 million

Egg on His Face

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Diner owner whose menu lampoons Obama guilty in welfare fraud case,” written by Mike McAndrew and published by on June 2, 2016.

The owner of a diner whose menu includes an ‘anti-government’ egg special that comes with a grossly inflated tax has admitted he defrauded the government of more than $23,000 in welfare benefits.

Michael P. Tassone, owner of the American Diner in suburban Liverpool, was sentenced May 5 to a one year conditional discharge after he pleaded guilty to offering a false instrument for filing, a misdemeanor. Tassone paid $23,354 in restitution to the Onandaga County Department of Social Services as part of the disposition of the five-year-old case.

As part of the resolution of the criminal case, the Onondaga County District Attorney’s Office dismissed a more serious felony welfare fraud case against Tassone.

Medicaid Raid

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Fayetteville, N.C. Woman Responsible For Creating Fake Patient Files In Medicaid Fraud Conspiracy Is Sentenced Prison,” a press release published by the U.S. Attorney General’s office on April 18, 2016.

According to information in filed court documents and today’s sentencing hearing, between October 2012 and August 2013, Melvin was involved in a Medicaid fraud conspiracy organized by the ring’s leader, Cynthia Harlan. Harlan owned and operated “Heartland Consulting and Marketing, Inc.,” a Charlotte-area company, purportedly specializing in the operation of mental health companies and Medicaid reimbursement. According to court records, Harlan executed a Medicaid fraud scheme involving the fraudulent submission of fake reimbursement claims to Medicaid for services that were never actually provided to beneficiaries. Court records show that Harlan relied on a network of conspirators, including Melvin, whom she had recruited to carry out the scheme.

From Community Support to Community Service

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Rutland Man Convicted For Falsely Obtaining Monies From The Vermont Medicaid Program,” a press release published by the Vermont Attorney General’s office on January 7, 2016.

Hal Curtis, 64, of Rutland, Vermont, was convicted on six misdemeanor counts of False Pretenses. The convictions stemmed from his submission of false timesheets to obtain payment for services that were not provided to a recipient of benefits in a Vermont Medicaid. The State alleged that Curtis filed timesheets purporting to show that he had delivered community support services while the recipient of benefits was sleeping.

Curtis was sentenced to three to six years of imprisonment, all suspended, and placed on two years of probation with 400 hours of community service. The Court also ordered Curtis to pay $12,938 in restitution.

Family Dysfunctions

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Woman Pleads Guilty to Medicaid Fraud,” a press release by the Georgia Attorney General’s office on January 22, 2016.

E’Terica Rucks was sentenced to two years in prison followed by eight years on probation after pleading guilty to Medicaid Fraud. As part of the sentence Rucks will have to pay restitution in the amount of $659,183.44 to the State.

Between July 19, 2010 and June 25, 2012, Rucks owned and operated Family Functions, LLC, which held itself out to the public as a behavioral health provider that served many Medicaid recipients in both the Atlanta area and at a satellite site in northern Georgia. An investigation by the Georgia Medicaid Fraud Control Unit revealed that Rucks’ business submitted numerous claims for payments that were fraudulent in nature.

Not Making the Grade

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Florida Couple Sentenced for Medicaid Fraud and Grand Theft,” a press release published by the Florida Attorney General’s Office on April 14, 2016.

TALLAHASSEE, Fla.—Attorney General Pam Bondi’s Medicaid Fraud Control Unit today announced the sentencing of a Palm Beach couple for Medicaid fraud and grand theft. David and Karen Bledsoe, owners of a durable medical equipment company named A Plus Medical Equipment and Supply, Inc., fraudulently billed the Medicaid program for more than $40,000 in services and medical equipment never provided to Medicaid recipients.

The defendants accepted payment from Medicaid for purportedly providing wheelchairs and bath chairs to Medicaid recipients, in this case, severely disabled children. David Bledsoe measured the recipients for the equipment, directed the billing and engaged in a campaign to mislead the recipients’ caregivers into believing the equipment was on its way. Karen Bledsoe was aware of the fraud and knew that her husband billed Medicaid even though the equipment had not been delivered.

The Honorable Krista Marx, Judge for the Circuit Court of the 15th Judicial Circuit, adjudicated David and Karen Bledsoe guilty of one count of Medicaid fraud and one count of grand theft, both second-degree felonies. The Honorable Krista Marx sentenced David Bledsoe to less than two years in prison, followed by four years of probation, and Karen Bledsoe to six years of probation, including two years of community control. The defendants are also ordered to pay more than $40,000 in fines and restitution.

Major Fraud Against Minors

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on, “Laxalt announces sentencing in Medicaid fraud case,” an Office of the Nevada Attorney General press release that was published by Elko Daily Free Press on March 16, 2016.

CARSON CITY – Nevada Attorney General Adam Paul Laxalt has announced the sentencing of a mental health clinic operator in Sparks in a Medicaid fraud case.

Kevin Jesus Cummings, 28, of Reno was sentenced for one count of submitting false claims, a category “D” felony; and one count of theft, a category “C” felony, related to Medicaid fraud. In February, his co-defendant Jessyca Gibson, 33, of Reno, was sentenced for intentional failure to maintain adequate records. The frauds were committed between January 2013 and May 2014.

The investigation began after the Medicaid Fraud Control Unit received information that Cummings had allegedly failed to provide mental health services through his company, Nova Behavioral Services LLC, to Medicaid recipient children in a foster program. The investigation revealed that Cummings had submitted false claims for services he did not in fact provide, and that Gibson had failed to maintain accurate records for the services.

“This crime, having been committed against vulnerable children in need, is especially egregious,” said Laxalt. “My office is committed to combatting Medicaid fraud to ensure the wellbeing of its recipients and safeguard taxpayer resources.”

Taken for a Ride

Commentary by: Larry Benson

Today’s ‘Fraud of the Day’ is based on “Ambulance fraud probe yields 37-month prison sentence for EMT,” written by John George and published by Philadelphia Business Journal on March 10, 2016.

A 39-year-old emergency medical technician was sentenced to 37 months in prison for his role in an health care fraud scheme perpetrated by a Philadelphia ambulance company.

Fritzroy Brown, of Philadelphia, was employed by Brotherly Love Ambulance Inc., where he transported patients who were able to walk and could travel safely by means other than ambulance — making them ineligible for ambulance transportation under Medicare requirements.

Brown and other conspirators at Brotherly Love Ambulance also falsified reports to make it appear that the patients needed to be transported by ambulance. In addition, Brown and other conspirators paid kickbacks to patients to ensure that they would use Brotherly Love Ambulance for services which were not medically necessary. Brown and others at the ambulance company also submitted documentation for transports that made it appear that the individuals had been transported in an ambulance when they had actually been driven in personal vehicles.

The founder and president of Brotherly Love Ambulance, Feda Kuran, 39, of Philadelphia,, was sentenced in 2014 to 64 months in prison after pleading guilty to health care fraud and paying kickbacks in violation of the federal Anti-Kickback Act.

From Fraud to Worse

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Woman who struck, killed pedestrian must pay state $300,000 for Medicaid fraud,” written by Emerson Clarridge and published by the Omaha World-Herald on March 5, 2016.

An Omaha motorist who struck and killed a pedestrian with her vehicle last year has been ordered by a judge to pay about $300,000 to the State of Nebraska because she fraudulently submitted Medicaid claims for mental health and substance abuse counseling.

Lawanda Cook, 42, submitted 1,599 claims from 2008 to 2014 to Nebraska Medicaid and a subcontractor for which no clinical records exist and was paid $208,506, the Nebraska Attorney General’s Office alleged in a civil suit.

A Lancaster County District Court judge overruled a motion for a rehearing that Cook filed and ordered Wednesday that she pay $312,759, 1½ times the amount of the claims.

Cook was sentenced in September to nine months in jail after she was found guilty of misdemeanor motor vehicle homicide.

Beware of the Heedless Horoscope

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on “Brinker gets more than 2-1/2-year prison term for fraud,” by Jennifer Bowman and published by the Battle Creek Enquirer on January 15, 2016.

MASON — Former Summit Pointe CEO Erv Brinker will spend more than 2½ years in prison for stealing a half-million dollars from the mental health agency he once was applauded for leading.

The 69-year-old was sentenced in Ingham County Circuit Court on Wednesday to 32 to 120 months of imprisonment after pleading guilty to three charges — two counts of Medicaid fraud and one count of embezzlement by a public official. Brinker admitted to paying a psychic $510,000 of public funds under fraudulent consulting contracts.

His sentence is nearly double the 17 months of prison time called for by criminal sentencing guidelines. Judge William Collette said the guidelines for such crimes “are absolutely ridiculous.”

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