Major Fraud Against Minors

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41913416 - medicaid torn newspaper headline on cash

Kids in foster care are among our society’s most vulnerable and deal with untold loss. Sadly, they also are among our most targeted for fraud, as is the case in today’s Fraud of the Day. The story, reported in the Elko Daily Free Press, details how a mental health clinic operator was found to have defrauded Medicaid by billing for mental health services that he never provided. The patients for whom he failed to provide care were children in the foster care system, and his criminal behavior lasted for nearly 18 months.(I propose a special place in you-know-where for those who commit this special category of fraud.)

Fortunately, someone tipped off the Medicaid Fraud Control Unit, which turned in the clinician, along with his co-conspirator, to the Office of the Nevada Attorney General (who rightly condemned the ”egregious” nature of these crimes). The 28-year-old clinic operator was charged with two felonies related to Medicaid fraud, and his 33-year-old assistant was charged with intentional failure to maintain adequate records.

The presiding judge sentenced the clinician to 19-48 months in prison for submitting false Medicaid claims and another 24-60 months for theft, which were both suspended for 60 months of probation. He was further ordered to pay $56,000 in restitution. Having been found guilty of intentional failure to maintain adequate records, his co-defendant was ordered to pay $7,000 in restitution. (Plus anyone convicted of Medicaid fraud can be excluded from future participation in Medicare and Medicaid.)

Minors in the foster care system: it’s hard to imagine a population more in need of the taxpayer-funded resources that were stolen from them in this case. But it’s not hard to imagine the lost opportunity to ensure the mental well-being of these children at a critical time in their lives.

Source: Today’s ”Fraud of the Day” is based on, ”Laxalt announces sentencing in Medicaid fraud case,” an Office of the Nevada Attorney General press release that was published by Elko Daily Free Press on March 16, 2016.

CARSON CITY – Nevada Attorney General Adam Paul Laxalt has announced the sentencing of a mental health clinic operator in Sparks in a Medicaid fraud case.

Kevin Jesus Cummings, 28, of Reno was sentenced for one count of submitting false claims, a category ”D” felony; and one count of theft, a category ”C” felony, related to Medicaid fraud. In February, his co-defendant Jessyca Gibson, 33, of Reno, was sentenced for intentional failure to maintain adequate records. The frauds were committed between January 2013 and May 2014.

The investigation began after the Medicaid Fraud Control Unit received information that Cummings had allegedly failed to provide mental health services through his company, Nova Behavioral Services LLC, to Medicaid recipient children in a foster program. The investigation revealed that Cummings had submitted false claims for services he did not in fact provide, and that Gibson had failed to maintain accurate records for the services.

”This crime, having been committed against vulnerable children in need, is especially egregious,” said Laxalt. ”My office is committed to combatting Medicaid fraud to ensure the wellbeing of its recipients and safeguard taxpayer resources.”

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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.