Number 13

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41913416 - medicaid torn newspaper headline on cash

Depending on where you hail from, the number 13 can be considered lucky or unlucky. Italy and China consider the two-digit number to be lucky, while most Western cultures believe the opposite, going as far as to omit 13 as a house number or as a floor in buildings or hotels. For 13 residents of a nursing home in Elkins, West Virginia, the number was definitively unlucky. A woman who worked as a social worker in the facility committed Medicaid fraud by financially exploiting 13 unlucky residents.

Over four years, the social worker stole more than $50,000 from residents at the nursing home where she worked. (In one instance, she used the personal bank account of one of her victims to make purchases at multiple local stores.) The social worker opened a second bank account in her victim’s name, claiming she was the administrator of the bank account. Then, the deceptive woman transferred funds from her victim’s original bank account to the new one that she controlled.

In addition to taking advantage of the nursing home residents, the social worker also defrauded the Medicaid program by causing more than $40,000 in bogus claims to be submitted to the government healthcare program. She intentionally failed to list the assets of one of her victims, which caused the Medicaid application to be approved and payments of more than $4,000 issued. (If all the assets had been listed, the victim would not have qualified for the government healthcare benefits.)

 The illegal payments were hidden from Medicaid administrators in the newly created bank account. Here’s where the West Virginia Department of Health and Human Resources (DHHR) Medicaid Fraud Control Unit entered the picture. (The organization’s mission is to protect the state’s vulnerable residents and the integrity of its healthcare programs.) An investigation into this woman’s criminal acts led to her arrest and indictment on one count of fraudulent schemes, six counts of financial exploitation, and two counts of Medicaid fraud.

The fraudster, who caused a total loss of $97,264.50 to her 13 victims and the Medicaid program was convicted of Medicaid fraud and received a sentence of one year in jail for financial exploitation and two consecutive terms of one to 10 years in prison on one count each of fraudulent schemes and Medicaid fraud. However, her prison sentences were suspended and instead, she received seven years of probation to begin after her release from jail. She must also pay full restitution. (I should say so.)

In this case, the number 13 was unlucky for the social worker, her victims and the Medicaid program. (It’s a good guess that everyone involved now has Triskaidekaphobia – an extreme fear or superstition of the number 13.) The lucky part of this whole situation is that the fraudster received a greatly reduced sentence and was given a second chance to rehabilitate her urge to defraud.

Today’s “Fraud of the Day” is based on an article entitled, “Nursing Home Employee Sentenced in Medicaid Fraud, Financial Exploitation of Patients,” published by the West Virginia Department of Health and Human Services on August 18, 2017.

The West Virginia Department of Health and Human Resources (DHHR), Medicaid Fraud Control Unit today announced that Mary Jane Brown of Belington was sentenced subsequent to conviction on multiple felony counts in Randolph County Circuit Court, including Medicaid fraud, financial exploitation and fraudulent schemes. 

The convictions resulted from a criminal investigation by DHHR’s Medicaid Fraud Control Unit, which determined that over the course of four years, Brown, a social worker employed by an Elkins nursing home, financially exploited 13 patients, stealing more than $50,000. Brown also caused more than $40,000 in fraudulent claims to be submitted to the Medicaid program.  The total loss to all victims including the Medicaid program was $97,264.59.

 

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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.