Someone Dropped the Ball

37175318 - medical team examining patient in hospital.

Home health or personal care aides provide personal care services such as meal planning and food preparation, companionship, medication management, transportation, bathing and dressing services to individuals who are ill, injured or disabled, elderly or fragile in general. (On average, Medicaid pays caregivers $8 – $14 per hour.) A Boise, Idaho caregiver committed Medicaid fraud by submitting fraudulent progress reports to her employer, who subsequently submitted bogus claims to Medicaid for reimbursement. (She neglected to tell her employer that the person she was supposedly providing care to was not at home.)

It’s common to read about Medicaid billing fraud where caregivers bill for more hours than provided, then pocket the extra cash. Today’s case is a bit different because although the caregiver claimed to provide in-home care, the person to whom she was supposed to be providing care to was actually in jail. (That person was receiving a totally different type of government-funded care.)

The caregiver was employed by a legitimate care provider company that got dragged into the Medicaid fraud scam thanks to the forging fraudster. (Someone at the care provider company dropped the ball though. They should have followed up with the Medicaid beneficiary to see if he was legitimately in need of care. And, when he was unable to verify he needed support, that should have raised suspicions.)

The 51-year-old Boise, Idaho woman pleaded guilty to 12 felony counts related to Medicaid fraud. Court records show that her employer paid Medicaid back for their employee’s crime. The deceptive caregiver was ordered by the judge to reimburse her employer for the proceeds of the crime, which was $1,905. She was also sentenced to serve 75 days in jail and perform 150 hours of community service.

While the ball got dropped by the fraudster (Did she really think that the government wouldn’t cross reference databases to find that her patient was incarcerated?) and her employer (it was probably an administrative error), the government definitely picked up the fraud ball and ran with it. All the way to court. Final score – fraudster 0, Medicaid 1. 

Today’s “Fraud of the Day” is based on an article entitled, “Boise care provider sentenced for fraud, ordered to repay company,” published by Idaho Press on March 5, 2019.

A judge sentenced a Boise health care provider to probation on Friday and ordered her to pay more than $1,900 to a private company after prosecutors say she defrauded it — and thus Medicaid — out of the money.

Kimberly Reed, 51, was employed by Living Independence Network Corporation as a care provider, according to a news release from the Idaho Office of the Attorney General. In the summer of 2015 prosecutors say she submitted fraudulent progress reports on care she provided to a client. That client, however, was incarcerated in the Ada County Jail during the time she claimed to have provided that care, and it wouldn’t have been possible for her to have cared for them. Living Independence later used her reports to bill Medicaid for the supposed services.

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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.