Deliberate

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Medicare and Medicaid beneficiaries who receive home healthcare services are required to use providers approved by the Centers for Medicare and Medicaid Services (CMS). (CMS is explicit on compliance requirements so that beneficiaries receive good healthcare and providers receive payment for their claims in a timely manner.) As you might imagine, there is a certain level of trust that must be present as some government healthcare beneficiaries have no one other than their home healthcare provider to watch after them. (That’s a very vulnerable position to be in.) An approved home health provider in Columbus, Ohio, took advantage of and betrayed the trust of his patients and the government by committing both healthcare fraud and tax fraud. (Just so he could increase the size of his wallet.)

One of the most common methods of committing healthcare fraud involves improperly billing Medicare and Medicaid for services purportedly performed. Sometimes those services are not performed at all. In other cases, they are performed by unqualified care providers. Today’s fraud article goes one step further. The Columbus-based home healthcare provider improperly billed Medicare and Medicaid for services provided by untrained employees with criminal backgrounds. (That’s a scary thought. Nothing like having someone in your home casing out the place while also providing personal care without any training.)

But that’s not all, folks. He wanted to optimize the amount of money he received by the government, so he provided falsified documents to his tax preparer claiming that he made no taxable income for two years. (His actual income during those two years amounted to $468,000. His bogus documentation cost the IRS) $126,000.) The fraudulent home healthcare provider also submitted fake business expenses to his tax preparer. The inflated business expenses reduced his company’s tax liability by about $600,000, causing another loss of $185,000 to the IRS.

Just as today’s fraudster was deliberate in betraying the public’s trust, the judge made a deliberate decision to hand down a sentence of 18 months in prison for committing healthcare fraud and tax fraud. The 50-year-old healthcare scammer from Columbus must also forfeit $300,000 and pay $392,000 in restitution to Medicaid and $311,000 to the IRS.

Let’s hope that others considering committing similar crimes get the message that the government does not tolerate any healthcare provider who puts a patient’s health and safety at risk. Congratulations to those agencies involved in detecting and shutting down healthcare fraud and tax fraud schemes such as today’s and holding perpetrators accountable.

Today’s “Fraud of the Day” is based on a Department of Justice press release, “Columbus Home Health Care Provider Sentenced for Fraud,” released on February 1, 2019.  

COLUMBUS, Ohio – The co-owner of Alpha Star Health Care Inc. was sentenced today in federal court to 18 months in prison for running home health care fraud and tax fraud schemes.

Ali Jama, 50, of Columbus, pleaded guilty in September 2018 to one count of making false health care statements and one count of making false statements to the IRS.

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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.