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The Centers for Medicare & Medicaid Services (CMS) reports that spending for freestanding home healthcare agencies amounted to $88.8 billion in 2015. Of that amount, Medicare and Medicaid accounted for 76 percent of home health spending. These two programs are plagued by deceptive home care givers who bill for services not performed, collect money they don’t deserve, and leave their patients at risk. Such is the story of today’s fraudster who was already serving time for the unfortunate death of a patient. The Medicaid fraud charges filed against the Oklahoma man finally caught up with him in an Arkansas court room.

This is definitely a sad story, so brace yourself before reading, especially if you have a loved one that depends on home healthcare. The defendant at the center of today’s case was negligent in his care of a 57-year-old man who had the mental capacity of a five-year-old due to the early onset of dementia. Over a period of six months when the defendant was supposed to be caring for this Medicaid beneficiary, the caregiver was actually gambling at a casino in Choctaw, Oklahoma. (Apparently, his player’s card indicated that he gambled 151 days during that time period and collected winnings on 14 days. Lucky for him, but not so much for his patient.)

His man he was supposed to care for was found dead in the woods, naked except for his socks. (You’ll see why that’s an important detail in a moment.) The coroner ruled that his death was due to dehydration and infection brought on by bed sores. (Things get a little weird here.) Additional research shows that the caregiver reported the man missing two days before he was found. He told investigators that his patient had left the apartment (in his shoes) with another man while the caregiver was taking a shower. In addition, police received a letter from the patient stating that he had gone to Missouri, but it turns out that the handwriting was a perfect match to the caregiver. (Go figure. And the shoes? His only pair was still in his closet.)

Sadly, it was determined that the caretaker had never sought medical care for the patient who had not received adequate nutrition over the six-month period. (The caretaker claimed that he had regularly taken the vulnerable man to lunch at restaurants and bathed him daily, but unfortunately, that was not the case.)

The 46-year-old former healthcare aide from Oklahoma, who was already serving 20 years in the Arkansas Department of Correction (ADC) for the murder of the deceased Medicaid patient, pleaded guilty to Medicaid fraud and theft of property by deception for billing the Arkansas Medicaid program for services he did not provide over six months. He was sentenced to an additional five years with another 15 years suspended. (Why would they suspend the extra years in prison? This crime was heinous.) The fraudster will pay $23,980 in restitution to the Arkansas Medicaid program for the services he billed for, but didn’t perform or failed to perform adequately. If he fails to pay a $7,500 fine and does not pay the restitution back the government healthcare program, he will be going back to prison.

What is so sad about this story is that the victim died at the hand of a man who didn’t respect the government program that was set up to care for his patient. (Nor did he have respect for anyone’s life but his own.) The Medicaid beneficiary was abandoned by his caregiver, but the government did not neglect the awful crime committed against the mentally disabled client. (It doesn’t seem right that this man has a chance of getting out of prison and moving on with his life, while his victim was imprisoned by fraud and died a horrible death.)

Today’s “Fraud of the Day” is based on an article entitled, OK Man Sentenced to Prison for Medicaid Fraud in ARposted on Fox16.com on July 21, 2017.

LITTLE ROCK, Ark. – Arkansas Attorney General Leslie Rutledge announced Friday the conviction of a Pocola, Oklahoma man for Medicaid fraud.

Shawn Howard pleaded guilty in Pulaski County Circuit Court and was sentenced to five years in the Arkansas Department of Correction (ADC), with an additional 15 years suspended. He will pay $23,980 in restitution to the Arkansas Medicaid Program if and when he is paroled. His sentence will run consecutively to a separate case prosecuted in Sebastian County. 

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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.