Do the Math

3

We’d all be more productive if we only had more hours in a day. (Think about this – one extra hour a day would tack on more than 15 additional days to your year. Sounds like time for a nice vacation to me.) An article published in the Salina Post tells about a personal care attendant who created a bunch of extra hours in her day so she could bill Medicaid for more money than she deserved.

The article states that for more than six years, the Kansas City woman falsely billed Medicaid for services she provided to two or more clients. To clarify, she claimed that services were provided to multiple patients at the same time while they were either hospitalized, in different locations or while the personal care attendant was attending her own doctor appointments.Apparently, she billed for more than 750 works days that all exceeded 24 hours. (The most she billed for was 39.5 hours in one day. Wow, I could really get a lot done if I had that much time in a day.)

The personal care attendant was able to get away with the scam because she used multiple billing agencies. (By submitting claims to several billing agencies, she was able to cover up the fact that she was charging for services that overlapped.)

The 55-year-old woman pleaded guilty to six counts of health care fraud. She was sentenced to 18 months in prison followed by three years of supervised release and must pay $251,573.32 in restitution to Medicaid.

According to the article, the personal care attendant program is the top source of fraud in state Medicaid programs. When the program is abused by perpetrators, such as the woman in this case, it prevents vulnerable beneficiaries from receiving the care they need to remain in their homes. This fraudster didn’t do the math when it came to calculating the risk of being caught by the government for her fraudulent actions. (She will be definitely counting the days until her release from prison plus the dollars she owes to the government.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Kan. Woman Sentenced for Home Health Care Fraud,” published in the Salina Post on February 9, 2015.

KANSAS CITY, Kan. – A Kansas City, Kan., woman working as a personal care attendant was sentenced in U.S. District Court last week for health care fraud based on fraudulent bills she submitted to Medicaid according to U.S. Attorney Barry Grissom and Kansas Attorney General Derek Schmidt.

Doris Betts, 55, was sentenced in U.S. District Court in Kansas City, Kan., by Judge Eric F. Melgren to 18 months in federal prison, three years supervised release, restitution to the Kansas Medicaid program in the amount of $251,573.32, and a forfeiture judgment in the same amount. Betts was charged in April 2014 with six counts of health care fraud. She pleaded guilty in U.S. District Court and was convicted in November in a joint enforcement effort between the U.S. Department of Health and Human Services/Office of Inspector General and Kansas Attorney General’s Office.

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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.