From Community Support to Community Service

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Billing the government for services you claim to have provided in the middle of the night is probably going to raise a few red flags. That’s exactly how the Vermont Medicaid Fraud and Residential Abuse Unit caught a Rutland man attempting to defraud Medicaid, according to a press release issued by Vermont’s Office of the Attorney General.

Apparently, the man bilked the state’s Medicaid program out of nearly $13,000 by submitting falsified timesheets, in which he alleged to have provided community support services in the middle of the night and early morning. (A bit sloppy, no?) Unfortunately for him, investigators with the state program noticed the after-hours time stamps and reported him to local authorities. (If Ben and Jerry decide to name a flavor after him, it might be called ”Doh!nuts”)

The 64-year-old man was later convicted of six misdemeanor charges of False Pretenses and received a three to six year prison sentence, which was suspended as long as he serves two years of probation and completes 400 hours of community service. (Daylight hours this time.) He also must pay $12,938 in restitution to the Vermont Medicaid program. He’ll stay out of jail, but likely will be barred from being a provider in federally funded health care programs for at least five years (by which time he will be almost 70, and maybe will know better.)

This is an example of a more obvious data anomaly that can serve as an indicator for fraudulent activity. Let this be yet another lesson that, when it comes to checking the claims submitted by state-sponsored benefits providers, even the small details could mean a lot.

Source: Today’s ”Fraud of the Day” is based on, ”Rutland Man Convicted For Falsely Obtaining Monies From The Vermont Medicaid Program,” a press release published by the Vermont Attorney General’s office on January 7, 2016.

Hal Curtis, 64, of Rutland, Vermont, was convicted on six misdemeanor counts of False Pretenses. The convictions stemmed from his submission of false timesheets to obtain payment for services that were not provided to a recipient of benefits in a Vermont Medicaid. The State alleged that Curtis filed timesheets purporting to show that he had delivered community support services while the recipient of benefits was sleeping.

Curtis was sentenced to three to six years of imprisonment, all suspended, and placed on two years of probation with 400 hours of community service. The Court also ordered Curtis to pay $12,938 in restitution.

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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.