Worker Bees

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It doesn’t matter how far down the food chain you are in a fraud scheme, if you get caught you’re going to have to face the consequences. A couple in Elizabeth, New Jersey just realized how true this is after admitting to their roles in a coordinated effort to bill Medicaid millions for home health care services that were never done or performed.

According to authorities, the fraud scheme involved two New Jersey home health care agencies, where the principal executives had individuals who had other jobs sign time cards saying they had worked as home health aides. The wife in this scenario did perform services as a home health aide through 2013, but signed off on time sheets under other individuals’ names, receiving cash payments from those individuals. (Guess the allure of ”free” money was more tempting than actually working for it.). She also billed for services that were not rendered at all and convinced patients to sign off on paperwork they knew was false. So, what was the husband’s role in the process? Well, he served as the ”chauffeur,” driving the wife to and from jobs knowing that it was for fraudulent purposes. (Wonder if he received any tips for good service?)

The attorney for the wife acknowledged her guilt, but called her “a worker bee,” while the husband’s attorney called him “the lowest man on the totem pole.” Although both avoided prison time for their low-level participation, they did receive three years probation, with the wife getting an additional four months of home detention. They also have to pay joint restitution of $223,702. (Now that’s a lot of honey…I mean money.)

So, what happened to the queen bee in this hive of fraud? She was recently sentenced to five years in prison for bilking the government out of $7 million.

Source: Today’s ”Fraud of the Day” is based on, ”N.J. couple avoid prison in $7M Medicaid fraud,” an article that ran on NJ.com on February 18, 2016.

An Elizabeth couple, described by authorities as low-level but essential players in a fraud scheme, avoided prison time for their roles in a plan to bill Medicaid millions for home health care services that were never done or performed by unlicensed aides.

Nelson and Sonia Mesa were sentenced to three years probation, with Sonia Mesa receiving four months of home detention Thursday by U.S. District Judge Katherine Hayden. Federal prosecutors had sought prison sentences for both, or at least a minimum of six months of home confinement.

Authorities said the scheme cost Medicaid, the joint state and federal health care program for the poor, their children and the infirm, roughly $7 million

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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.