When the Fraud Hits the Fan

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Today’s fraud is a real doozy. The Alton Telegraph reported in a story on October 15 that a woman from Brighton, Ill., who offered her services as a personal assistant and nurse to elderly Medicaid patients, pleaded guilty to improperly billing state Medicaid programs for 111 hours that she did not work between December 7, 2012 and June 30, 2014, and relatedly for more than $1,300 in services never performed. (Her actions were deplorable not only because of how she defrauded Illinois, a financially struggling state, but also because her patients were some of the neediest.)

The story explains that this fraudster was the nurse to Medicaid recipients who opted into a program which allows seniors to maintain their private residences and receive treatment where they would otherwise need move to a nursing home. This fabricating fraudster furthermore admitted that as part of her fraud, she stopped seeing one of her clients for one week while continuing to bill the government for hours she never worked. The client was later discovered by a friend who was checking in, and that friend found the senior citizen incoherent and covered in dry excrement. (Everything about this story stinks.)

The defrauding nurse was caught by a cooperative effort between the Office of the Inspector General of the US Dept. of Human Services, the Federal Bureau of Investigation (FBI), the Medicaid Fraud Control Bureau of the Illinois State Police, and the Wood River Police Department. She was caught as part of ”Operation Home Alone,” an initiative designed to reduce instances of Medicaid fraud when seniors receive at-home treatment, and also to ensure the protection of those seniors. (Differentiating this law enforcement operation from the famous Home Alone movie series is that in these cases, the culprits are caught through a process with fewer hijinks.)

This fraudster will face up to 10 years in prison, and could be fined no more than $250,000 by the state of Illinois at her sentencing proceeding. We await her sentencing hearing, where we will learn more about how much time she’ll have to make up for the time she spend defrauding needy seniors and her state government. (My guess: probably more than 111 hours.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Brighton woman pleads guilty to healthcare fraud,” and published by The Alton Telegraph on October 15, 2015.

Brighton Woman Pleads Guilty To Healthcare Fraud Offense

BRIGHTON —A Brighton woman has pleaded guilty to federal healthcare fraud charges, submitting fake bills to a Medicaid waiver program as a personal assistant. She also admitted to neglecting one of her customers.

U.S. State’s Attorney Stephen R. Wigginton announced Thursday that Jessica A. Teets, 27, of Brighton, pleaded guilty in the U.S. District Court on Tuesday to the charge that she engaged in a scheme to defraud a health care program.

Sentencing has been set for Feb. 9, 2016, in East Saint Louis. Teets will face up to 10 years in prison, a fine of up to $250,000, and up to three years of supervised release.

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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.