The Fraudster Next Door

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How well do you know your next door neighbors? You might converse with them at the annual neighborhood party, toss their daily newspaper over the white picket fence as a friendly gesture or offer to watch their house while away on vacation, but do you really know much about them? An article in the Southeastern Missourian reports on a man who lived next door to a company that provided in-home health care services. According to prosecutors, the neighbors conspired to defraud Medicaid of nearly $15,000.

It’s hard to find good neighbors that you can trust. (You would think it might be even harder to find a neighbor that would be willing to commit a crime with you.) According to the article, the 48-year-old neighbor already had a criminal history. Court documents say the home health company created time sheets indicating the neighbor had received in-home care services despite being able to drive, mow the grass, do construction work and paint.

In addition to the neighbor, prosecutors say the conspiracy involved several family members. According to court documents, a husband and his wife, who happened to be the co-owner of the company, and their daughter, were listed on the company time sheets as providing personal care services for the neighbor, as well as other patients. This is where the story gets a bit more complicated.

The daughter happened to be a former deputy sheriff, who is serving time in prison for possessing and selling a stolen firearm related to an investigation involving the former sheriff. (So how could she have performed the in-home care services as indicated on the time sheets while in prison?) It also turns out that the neighbor had been previously involved with arson and burned multiple homes within the county, including the modular house belonging to the former sheriff. (Now there’s an interesting connection.) He also was guilty of distributing methamphetamine to an informant and an undercover agent. (Okay…so that wasn’t necessarily relevant to the Medicaid fraud case, but it was interesting.)

The article states that the neighbor entered into plea negotiations that resulted in a probation sentence for his role in the Medicaid fraud scheme. His sentence on the counts for arson and distribution of a controlled substance is pending.

It is important to note that only the defendant in this case has been found guilty of Medicaid fraud. Others, who have been accused of being involved in the case, are innocent until proven guilty. Even so, it looks like there will be no more neighborly services provided and probably no more friendly waves as the defendant heads off to prison. White picket fences will be replaced by cell bars as he moves into a whole new kind of neighborhood.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Judge Orders Probation in Medicaid Fraud Case; Other Issues Pending,” written by Michelle Friedrich and published by the Southeaster Missourian on June 12, 2014.

A federal judge has placed a former Ellsinore, Missouri, man on probation for his role in a Medicaid scheme.

Gary Wayne Bender, aka “Goober,” who pleaded guilty in March to one felony count of health-care fraud, was sentenced Monday to time served by U.S. District Judge Stephen Limbaugh Jr.

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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.