Losing Control

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36599165 - stethoscope and laboratory result, medical insurance concept.

Many people have a fear of losing control. In a world already full of uncertainty, fraudsters attempt to control their destiny by stealing from others so that they can live a more predictable, comfortable lifestyle. (Unfortunately, these unscrupulous individuals perpetuate even more anxiety for their victims.) An article posted on NJ.com explains how the owner of a home health care agency controlled a massive fraud scheme that bilked Medicaid out of more than $7 million.

The story states that the home health care agency owner billed Medicaid for aide visits that did not occur. (Apparently, the health care workers were vacationing overseas, working other jobs or out of town during the dates of service listed.) The owner also authorized the payment of some patients to vouch for the fraudulent dates of service.

Further research revealed that the owner also falsely represented that the home health aides employed by her company were certified to perform their duties after receiving the appropriate training and testing. In reality, the aides – some illegal residents – had paid hundreds of dollars to obtain fraudulent certification documentation. (What’s next, uncertified illegal residents performing surgery?)

The owner began to lose control of the scheme when she attempted to bribe a Department of Labor employee working undercover with federal agents. (The Department had received a complaint that the business was not paying overtime wages to her employees.) When the Department requested that the owner provide company records, she knew her scam would be revealed, so she paid a $10,000 cash bribe instead. (The exchange, plus another $15,000 bribe, was caught on video.)

As if this fraudster was not already in enough hot water, she also failed to pay more than $900,000 in taxes to the Internal Revenue Service (IRS). These taxes were based on fraudulent charges billed to patients who were not eligible for Medicaid and paid outright for the services they received.

The 61-year-old woman faces up to 10 years in prison for each conspiracy to commit health care fraud, bribery and money laundering. The tax evasion charge could add an extra five years to her sentence. In addition, each charge is punishable by a fine of $250,000. She was ordered to pay $7 million and forfeit several homes and properties located in New Jersey, New York and Florida.

In the end, this fraudster’s scam spun out of control, leaving her in a very precarious position. There will be no more money left for new homes, property, or personal luxury items. (It looks like her next vacation will be a lengthy term spent in a federal gated community.)

Source: Today’s ”Fraud of the Day” is based on an article entitled ”Owner of N.J. Healthcare Agency Admits to $7 Million Fraud, Bribery, and Tax Evasion” posted on NJ.com on April 20, 2015.

NEWARK — The owner of a Linden home health care agency pleaded guilty to carrying out a multimillion dollar Medicaid fraud, bribery and other offenses that could lead to decades in prison, the office of U.S. Attorney for New Jersey Paul Fishman announced Monday.

Irina Krutoyarsky, 61, of Springfield, owner of HHCH Health Care, is scheduled to be sentenced in September after admitting she told the state’s Board of Nursing that the aides she employed had completed required training and testing when in reality she charged the aides hundreds each for obtaining fraudulent credentials.

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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.