Lower the Fraud Boom

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47847021 - nurses pushing seniors in wheelchair thru nursing home

Personal care attendants are key to helping the disabled and elderly live as independently as possible. Some of the duties performed include helping patients with personal hygiene, light housekeeping and meal preparation. Medicaid pays to provide such personal care to eligible beneficiaries so they can stay in their own homes instead of being placed in facilities, which can actually increase costs for the government benefits program. (But as you know, wherever benefits are doled out, fraudsters are lining up to take what is not theirs.)

An article posted on KMOV.com covers how a personal care attendant in Missouri billed Medicaid through four companies for which she worked. The trouble was spotted when she reportedly provided services to two or three patients at the same time. (This woman is either super-efficient or good at falsifying forms. My guess is the latter.)

The 55-year-old woman pled guilty to two felonies of Medicaid fraud and one felony of stealing by deceit. (Deceitful is definitely the correct word to use for her illegal behavior.) She is required to serve five years of probation and pay a total of $25,000 to Missouri’s Medicaid program. (I’m guessing she won’t be working as a personal care assistant anymore.)

As the Baby Boomer generation ages and demand for personal care services increases, there will be more opportunities for criminals to steal valuable health care benefits on behalf of their unsuspecting patients. Government agencies responsible for these programs and the companies who participate in them need to keep lowering the boom on this fraud.

Source: Today’s ”Fraud of the Day” is based on an article, ”Personal care assistant required to pay $25,000 for Medicaid fraud,” published by KMOV on July 1, 2016.

JEFFERSON CITY, Mo. (KMOV.com) – A personal care attendant will serve five years probation and be ordered to pay back $25,000 to Missouri’s Medicaid Program.

Yvonne Conly was originally sentenced to serve three concurrent prison sentences of five years, following her guilty pleas for Medicaid fraud back in May of this year.

Conley worked for four different personal care companies that had contracts with Medicare. She would provide healthcare services to patients in their homes, and then submit reports on all the services she provided.

January 2012 to October 2012, Conley reported that she provided healthcare services to two-or-three different patients at the same time on the same day.

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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.