For Rent

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Renting has advantages. For instance, if you rent a house, you are responsible for taking care of the place but, you’re not stuck with a mortgage when you move out. When you rent a movie from your cable provider, you get to enjoy a flick for the evening in the comfort of your own home without the added expense of driving to the theater, a long ticket line, expensive snacks or being surrounded by people you don’t know. An article published by The Charlotte Observer tells about three women and a $6 million Medicaid fraud scheme that involved renting out one of the women’s Medicaid provider number.

Court documents show that one of the women, who was a licensed social worker approved to bill Medicaid and receive reimbursement for therapy services provided to Medicaid recipients, allowed co-conspirators to submit fraudulent claims using her provider number. (As you might guess, the services were never provided.) In exchange for her provider number, she received monthly payments from the co-conspirators’ companies for the bogus therapy services. Further research revealed that the co-conspirators obtained the personal identifiable information from approved Medicaid beneficiaries by paying them in cash, food or taxi rides. In one instance, Medicaid was billed for 140 hours of therapy in one day. (Did they really think that no one would catch that?)

The two other women involved in this case owned and operated a company that used the licensed social worker’s provider number to illegally bill Medicaid for outpatient mental and behavioral health services. (Apparently, the two billed Medicaid for 77 hours of services in one day then used the benefit payments to pay for personal expenses including jewelry and a wedding. They should have spent a few bucks on a calculator instead.)

In the end, the three women pleaded guilty to billing Medicaid for services they did not provide and will collectively be required to pay more than $2.1 million in restitution. The 36-year-old woman with the Medicaid provider number received a sentence of 44 months in prison for billing Medicaid for behavior and mental health services she didn’t provide. Her 38-year-old and 37-year-old accomplices received 42 months and 35 months in prison, respectively.

It looks like these three women will be renting out a jail cell for the next couple of years, although taxpayers will ultimately foot the bill. Even though the living situation for these women is temporary, they will ultimately end up paying for their illegal acts by receiving a permanent criminal record.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Charlotte Woman Sentenced for Medicaid Fraud,” written by Sam Hardiman and published by The Charlotte Observer on August 18, 2015.

Three Charlotte women were sentenced Tuesday for Medicaid fraud after scheming to steal almost $6 million from the government, said Jill Westmoreland Rose, Acting U.S. District Attorney for Western North Carolina.

The three women will pay a combined $2,147,550.27 in restitution to Medicaid after pleading guilty to billing the government for services they didn’t provide, Rose said.

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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.