Flexibility

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The state of Kentucky’s Office of Medicaid Fraud and Abuse aims to protect Medicaid patients who are in nursing homes, being treated in Medicaid facilities or receiving personal care in their own homes from patient abuse, neglect and exploitation. One of the most important goals of the state’s Attorney General’s (AG) Office is to investigate and prosecute healthcare providers who fraudulently bill or abuse the state’s Medicaid system. That goal was recently achieved when the AG’s office successfully investigated and prosecuted a woman who tried to defraud the system through bogus documentation.

An article in The Daily Independent stated that the woman was employed to manage services for qualified Medicaid recipients enrolled in the state’s Consumer Directed Options (CDO) Program, which allows patients to receive non-medical care in their home. The CDO program allows for greater flexibility and choice of providers for eligible beneficiaries. (The problem arose when the employee challenged the flexibility of the program by submitting fraudulent documentation to Medicaid for services not rendered. The government – of course – was not willing to stretch the Medicaid program’s boundaries to fund a criminal.)

The woman carried out her scheme by filling out and submitting incorrect timesheets showing that she had provided personal care to a Medicaid recipient in the patient’s home; however, records proved otherwise. The woman admitted to submitting the bogus timesheets while also billing and receiving payment for transporting other patients at the same time. (She probably figured that no one would double check to see if she had charged Medicaid for being in two places at once. Thank again!)

The 56-year-old fraudster was convicted on two felony counts of Medicaid fraud and sentenced to one year on each count, to run concurrent. The court probated her sentence and she paid restitution of $1,640 prior to being sentenced. (That action probably helped to get her sentence probated.)

While $1,640 in fraud doesn’t sound like a lot, the AG’s office went after this criminal to prove a point. The government doesn’t like it when vulnerable people are taken advantage of, regardless of how much money is stolen. The outcome further reinforces the idea that the government is inflexible on rules and regulations established to protect those who are legitimately qualified to receive government health care benefits.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Beshear: Elliott County woman sentenced for Medicaid fraud,” published by The Daily Independent on October 25, 2016.

FRANKFORT Attorney General Andy Beshear and his Office of Medicaid Fraud and Abuse today announced an Elliott County woman has been sentenced on felony charges for Medicaid fraud.

Ruby Fraley, 56, of Isonville, was convicted earlier this month in Elliott Circuit Court on two counts of Medicaid fraud, both Class D felonies. Her sentencing was in Morgan Circuit Court this week, where she was sentenced to one year on each count, to run concurrent. The court probated her sentence. Additionally, Fraley paid $1,640 in restitution in advance of her sentencing.

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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.