A Degree of Separation

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At times, the smallest amount of something can make the largest difference. For example, you are constructing a skyscraper and lay the foundation just a few degrees off the planned measurement. A couple years down the road, an earthquake hits and brings the building crashing down. If the building had been placed on the exact dimensions, it probably would have been survived the tremor. Could a small degree of separation have the same catastrophic result in fraud? According to an article in The Wetumpka Herald, it depends on what type of ”degree” we are talking about.

Authorities in Wetumpka, Alabama discovered a local business woman to be the brains behind a Medicaid fraud scheme that cost the government nearly $190,000. The woman owned a non-profit corporation that provided psychotherapy services to families and students. The services focused on counseling children with behavioral issues, as well as providing support and training to families coping with that type of issue. While counseling children with behavioral problems is no easy job, it leaves us wondering how the woman had time to run her business and defraud the government at the same time.

The business owner pleaded guilty to one count of health care fraud, admitting to falsely billing Medicaid. She explained that the therapist who had provided the counseling services billed Medicaid as if the services were provided by a psychologist with a doctoral degree, while in reality, the services were provided by a therapist with a master’s degree. (It may seem like a small technicality, but that is quite a different degree.) The fraudster was able to make more money from the false filing than she was legally owed. She faces five years in prison and a $250,000 fine, in addition to repayment of the $190,000 that was stolen from Alabama’s Medicaid program.

It’s amazing what a small degree of separation can do. Had the precise degree of qualification been properly billed, this woman could be sitting on a business of success. Instead, she will be sitting in a court room waiting to hear her prison sentence.

Today’s ”Fraud of the Day” is based on an article titled, ”Local Woman Sentenced for Medicaid Fraud,” written by Kevin Taylor and published by the The Wetumpka Herald on July 15, 2013.

Source: Today’s ”Fraud of the Day” is about a Wetumpka woman is facing up to five years in prison and fines up to $440,000 after pleading guilty to Medicaid fraud.

LaShawn Denise Anthony, 42, pleaded guilty to one count of health care fraud on Thursday, admitting that she and her business falsely billed Alabama Medicaid more than $190,000.

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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.