Dialing for Medicaid Benefits

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There are many organizations who use phones to raise funds to keep their programs up and running. They reach out to potential donors by calling for monetary support. Today’s “Fraud of the Day” explains how a woman and her son dialed into a New York Medicaid program telephone system and stole benefits they did not deserve.

A Utica woman at the center of today’s case was disabled and received in-home care services through the Consumer Directed Program operated by the Resource Center for Independent Living. Through this program, the woman remained in her own home living independently instead of in a skilled nursing facility, which is more expensive. (The disabled woman chose family members, including her son, to be her personal in-home care providers.)

The disabled woman’s caretakers were required to call the state Medicaid program from her home phone line and use a personal PIN to log in when they began providing care and also when they clocked out for the day. Investigators found that the son was actually working another job during the time he was claiming he provided in-home care for his mother. (The mom was using her son’s PIN to log bogus hours. They split the paychecks between them.)

The 56-year-old mother admitted to helping her son steal $5,693.74 from the state Medicaid program by entering a guilty plea to petty larceny. (The son previously entered a similar plea.)

As part of the plea agreements, the mother and her son will be jointly responsible for full restitution.

New York’s Medicaid program generously offers beneficiaries the flexibility to choose, employ, train and supervise the staff they want to provide care for them in their homes. This woman and her son took advantage of a program that was set up to provide health care benefits for vulnerable patients who genuinely need assistance. (It looks like these two will no longer be able to dial for Medicaid dollars and will forfeit the amount that they stole.)

Source: Today’s “Fraud of the Day” is based on an article entitled, “Mother and Son Plead Guilty to Medicaid Fraud” posted on wibx950.com on January 25, 2017.

A Utica woman has pleaded guilty to helping her son steal over $5,000 in Medicaid benefits through the Consumer Directed Program operated by the Resource Center for Independent Living.

Attorney General Eric Schneiderman says 56-year old Karen Pierce entered a plea of guilty to petty larceny in Utica City Court today.  Pierce admitted she helped Robert Garrett steal over $5,600 from the Medicaid program.

 

 

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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.