Monkey See, Monkey Do

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Parents’ actions often speak louder than words. And, when children observe their parents repeating the same behavior frequently, they tend to copy. (Monkey see, monkey do.) A woman from Placentia, California emulated her mother’s repetitive criminal behavior and followed her lead right into a healthcare fraud scheme because she bought into the lie that fraud is lucrative. (It is, until you get caught.)

 The daughter and four others were involved in the scam masterminded by the mother, who owned a former Covina-based hospice care company. The ringleader purchased the business in late 2007, while under investigation for a separate healthcare fraud case that involved using unlicensed nurses. (She eventually served 54 months in prison following her conviction for that crime.)

 Here’s how the scam went down. The mother and daughter paid recruiters to bring in Medicare and Medi-Cal beneficiaries to the hospice center for evaluation. Nurses then performed a health assessment on the new patients, and regardless of the results, two doctors employed by the business would certify that the patients were terminally ill and in need of hospice services. (That could be earth shattering news for the patient, who didn’t realize they were so sick.)

When Medicare requested audits, personnel at the hospice care center altered medical records to make the government healthcare beneficiaries appear to be sicker than they were. For more than four years, the hospice company submitted nearly $9 million in fraudulent bills to Medicare and California’s Medicaid program, Medi-Cal.

Five individuals in addition to the hospice care owner were prosecuted in this case. The ringleader admitted to her role in the fraud scheme and received a sentence of eight years in prison and must pay more than $7 million in restitution. Her 47-year-old daughter (today’s fraudster) was sentenced to five years of probation. Her healthcare fraud sentence involves home confinement because of her son’s health condition. (She got off easy on the jail time, but must pay back $7.4 million in restitution.)

As for the other co-conspirators, one doctor had his medical license revoked and is currently serving 27 months in prison to be followed by three years of supervised release and the payment of millions of dollars in restitution. The other doctor involved must serve four years in prison and pay back more than a million in restitution. The 74-year-old nurse who recruited patients has pleaded guilty to her role and is waiting to be sentenced. Information concerning another nurse recruiter was unavailable.

Today’s fraudster was old enough to know better than to follow her mother into a criminal lifestyle, but unfortunately family ties usurped her ability to make a good decision. (Maybe you feel sorry for the fraudster because her mom was such a bad parent, but I feel worse for the patients who received fake diagnoses. I’m sure that caused a lot of stress for the patients and their family members.) There’s a lesson in this case – more is caught than taught, so be careful how you behave. Others are definitely watching, especially the government when it comes to fraud.

Today’s “Fraud of the Day” is based on an article entitled, Placentia woman gets probation for aiding fraud: Medicare, Medi-Cal charged end-of-life care for patients not dying,” published by The Orange County Register on November 27, 2017.

A Placentia woman was sentenced Monday to five years of probation for her role in a multi-million-dollar hospice fraud in which Medicare and Medi-Cal were charged for end-of-life care for patients who actually were not dying.

Sharon Patrow, 47, was ordered to spend a year of her probation in home detention, and to pay approximately $7.4 million in restitution, according to the U.S. Attorney’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.