No Walking Allowed

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Calculator and stethoscope on paperwork

Healthcare fraud is often misconstrued as a victimless crime, but the truth is that it impacts the most vulnerable members of society who rely on the services provided by government healthcare programs. Michael Wilson and Jacqueline Podell of Winamac, Indiana are two individuals who tried to take advantage of the government’s healthcare system for their own benefit.

Wilson and Podell attempted to defraud Medicare and the Indiana Medicaid Program from 2010 to 2014 by submitting false ambulance transport claims. They ran an ambulance transport company that operated either as Transport Loving Care or Alliance EMS. The company transported four patients to dialysis using an ambulance even though the trip was not considered to be a medical necessity. (Ambulances are so expensive that some people prefer using ridesharing services to reduce costs.)

None of the patients required ambulance transportation as they could walk on their own. Wilson and Podell filed false reimbursement claims indicating that the dialysis patients had physical conditions that required them to be transported via ambulance. They lied about the necessity as Medicare and Medicaid do not pay healthcare providers for services that are not medically required. (Healthcare insurance doesn’t always cover necessary procedures, let alone unnecessary ones.)

Ambulance staff reportedly questioned why they were transporting patients who were not physically unable to transport themselves. Employees were told that it was not their concern. (Being told it was ‘above their pay grade’ did not reduce their suspicion of company wrongdoings.) They were also instructed not to use the word “walked” on run sheets for patients being transported to dialysis.

A grand jury indicted Podell and Wilson on one count of conspiracy to commit Healthcare fraud, four counts of Healthcare fraud and one count of Medicaid health care fraud. Podell was sentenced to six months in prison and six months of home confinement once released. Wilson received 18 months in prison. (Being the brains behind the operation often means you serve the most time.)

Their ambulance scheme cost Medicare $2 million. Indiana Medicaid was also fraudulently billed for tens of thousands of dollars. Podell and Wilson now owe $985,490.27 in restitution to Medicare and $8,154.19 to Indiana Medicaid.

The U.S. Department of Health and Human Services’ Office of Inspector General released a statement reassuring the public that they will continue to identify and hold accountable those who seek to defraud federal healthcare programs and waste taxpayer dollars.

Today’s Fraud of the Day comes from a Department of Justice press release, Defendants Sentenced And Ordered To Pay $993,644.46 In Restitution,” dated June 12, 2020.

HAMMOND- Jacqueline Jay Podell, 46, and Michael Wilson, 53, both of Winamac, Indiana were sentenced before U.S. District Court Judge Philip Simon, announced U.S. Attorney Kirsch.

On December 13, 2019, defendant Podell entered a guilty plea to conspiring to commit health care fraud.  Defendant Wilson entered his guilty plea a month later to the charge of participating in a health care fraud scheme.   Defendant Podell was sentenced on June 11, 2020 and received 6 months in prison and 6 months home confinement.   Defendant Wilson was sentenced today and received 18 months in prison.

 

 

 

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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.