This Boat Don’t Float

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It’s tough for small business owners to keep their companies afloat without qualified, hardworking employees. The owner of a small Minnesota company that provided personal care assistants (PCAs) for disabled clients misrepresented her staff’s qualifications to Medicaid through the submission of $601,000 in fraudulent reimbursement claims over five years. Unfortunately, the woman at the helm of this sinking ship could not bail fast enough to keep her company afloat.

The personal care business owner claimed that her PCAs were working the maximum hours allowed by Medicaid, when they were actually working less. She also neglected to run background checks on her new employees because she claimed the process took too long and she didn’t want to pay the $20 fee. (Perhaps that move benefitted her company’s bottom line, but it also neglected her patients. Would you want an unqualified worker who had not passed a background test to provide personal care to a loved one?) The business owner falsely reported to the government that the employees who were providing personal care had passed the required background checks. (Obviously, they had not.)

 The business owner admitted that she did not have a qualified supervisor on staff for multiple months. She also stated that she had struggled to retain her employees and meet expanding state requirements, while also making a profit. (So, she threw her patients overboard and sacrificed their care for a better profit margin.)

The 51-year-old woman pleaded guilty to six felony counts of theft by false representation for deploying unqualified PCAs and submitting false reimbursement claims. She was sentenced to one year in jail and must pay $601,000 in restitution. Although she was ordered to serve 20 years on probation, she received a stayed 68-month prison sentence that could be executed if she fails to make restitution payments or violates her probation terms. (The judge essentially threw her a life jacket. It’s hard to pay restitution if you aren’t allowed to work.)

While the fraudster expressed that she wished she could “undo” her fraudulent actions during the time her business was going through a “rough patch,” her aspirations to provide quality care to her patients who were “like family” got tossed when she panicked and decided to defraud the government. (Perhaps the moral of the story is that when setting sail on an adventure to run a small business, make sure you have a good plan that doesn’t involve stealing from the government. Or in simpler terms, make sure your boat floats.)

Source: Today’s “Fraud of the Day” is based on an article entitled, Former business owner sentenced to year in jail for Medicaid fraudpublished by Mankato Free Press on June 5, 2017.

MANKATO — A Mankato woman who made $600,000 in fraudulent Medicaid claims says she was struggling to keep her business afloat and didn’t want her clients with disabilities to go without care.

Rebecca Swanson, 51, owned a small business providing personal care assistants, or PCAs, to people with disabilities. She was sentenced Monday in Blue Earth County District Court on charges she deployed unqualified PCAs and submitted false Medicare reimbursement claims.

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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.