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.”

Practical Nurse, Impractical Fraud

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on “LPN pleads guilty in Medicaid case” and “LPN to pay back state in Medicaid fraud case,” two Rochester Democrat & Chronicle reports by Patti Singer published on November 3, 2015 and January 5, 2016, respectively.

Schmeka Morgan, 34, of Rochester, faces three-years of probation and repayment of $8,838 to the state. The plea was entered Monday in Brighton Town Court.

Morgan had been charged with one count of third-degree grand larceny, a felony, and eight counts of first-degree offering a false instrument for filing, also a felony.

The complaint alleged that Morgan, working as a private duty nurse for a young adult with special needs, falsely billed for 42 hours of services on eight days from Dec. 25, 2014 to March 29, 2015. She was accused of stealing $8,838 from the Medicaid program.

Culture Shock or Shocking Fraud?

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Woman guilty of one of the biggest cases of benefits fraud in the Bronx avoids jail after paying back $85k,” written by Ben Kochman and published by The New York Daily News on Oct. 20, 2015.

She bilked the city out of thousands — and paid big.

A Bronx woman who committed one of the borough’s biggest ever case of benefits fraud got off with five years’ probation Tuesday after paying back a hefty chunk of cash.

Parvattie Raghunandan, a Guyanese immigrant who misrepresented her family’s income for a decade — netting thousands in fraudulent Medicaid payments — received the jail-less sentence in Bronx Supreme Court after paying back over $85,000 and pleading guilty to grand larceny.

No Work, No Pay

Commentary by: Larry Benson

Today’s “Fraud of the Day” is based on an article titled, “Iola man ordered to repay $7,000 for Medicaid fraud,” written by News Release and published by KOAM-TV on Nov. 4, 2015.

An Iola man was ordered today to repay $7,000 to the Kansas Medicaid Program after pleading guilty to Medicaid fraud-related charges, Kansas Attorney General Derek Schmidt said.

Kim Alan Laymon, 53, pleaded guilty in September in Neosho County District Court to one count of theft. Judge Daryl Ahlquist today ordered Laymon to repay $7,000 to the Kansas Medicaid Program. Judge Ahlquist also sentenced Laymon to 12 months probation with an underlying sentence of seven months in prison. Convictions such as this one also result in a period during which the defendant is prohibited from being paid wages through a government health care program.

All Aboard the Fraud Train

Commentary by: Larry Benson

The article states that this case was part of the largest crackdown ever on health care fraud in the District of Columbia. As a result, more than 25 others have been charged in separate cases. Congratulations to the investigators and prosecutors in this case for derailing this couple’s fraudulent itinerary.

Today’s “Fraud of the Day” is based on an article titled, “Federal jury convicts MD. couple in $80 million D.C. Medicaid fraud case,” written by Spencer S. Hsu and published by The Washington Post on Nov. 12, 2015.

A federal jury on Thursday convicted a Bowie, Md., couple of orchestrating a multi-year campaign to defraud D.C. Medicaid of more than $80 million between 2009 and 2014, the largest local health-care fraud scheme ever prosecuted in the city.

After a four-week trial in federal district court in the District, the jury deliberated two days before convicting Florence Bikundi, 52, of four counts of health-care and Medicaid fraud and conspiracy, and her husband, Michael D. Bikundi Sr., 63, of two counts of fraud and conspiracy through her company, Global Health Care Services of the District.

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