A Not So Tender Heart

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Calculator and stethoscope on paperwork

Some people are called to the medical field because of their endless compassion and desire to care for people. Others work in the medical field because of their greed and the opportunity to exploit others.

Katrina Lynch of Cypress, Virginia used her position in the medical field to take advantage of the system and the people she was supposed to serve. Lynch owned and operated a medical company that defrauded Medicaid of millions of dollars.

Lynch’s company, A Tender Heart, was a Service Facilitator through the Virginia Medicaid Program. A Service Facilitator is enrolled as an independent Medicaid provider or as an employee of a Medicaid-enrolled Services Facilitation company. (Lynch didn’t have a tender heart, but a hard heart. The only thing her heart was set on was making lots of money at the expense of her victims.)

Service Facilitators assist patients in using medical devices, partake in home wellness visits, and help provide care to those in need of assistance.  (Fraudsters now conveniently come to your home.) A Tender Heart was entrusted to provide Medicaid beneficiaries with the medical equipment and services that they needed. (I would not recommend entrusting them with your checkbook.)

Bills were fraudulently submitted to Medicaid for services never provided between 2011 and 2018. These fraudulent billings include allegedly providing services to beneficiaries that were deceased, hospitalized, had changed Service Facilitators, or were no longer in need of services. This scheme cost the Virginia Medicaid Program more than $2.8 million dollars.

Lynch pleaded guilty in July 2020 to one count of healthcare fraud. She is scheduled to be sentenced on December 1, 2020. The maximum penalty for healthcare fraud is 20 years in prison. (Fortunately for Lynch, the prosecutors have not asked for the maximum sentence in this case, but it’s a good guess that she will also be ordered to pay some form of restitution.)

Each state has a Medicaid Fraud Control Unit that investigates and prosecutes Medicaid fraud. Their goal is to ensure that there is no patient abuse in healthcare facilities or fraudulent billing practices occurring. To file a formal fraud complaint, contact your state’s Office of the Attorney General’s website.

Today’s Fraud of the Day comes from a Department of Justice press release, “Owner of Virginia Company Pleads Guilty to $2.8 Million Medicaid Fraud,” dated July 7, 2020.

RICHMOND, Va. – A Texas woman pleaded guilty today to defrauding the Virginia Medicaid Program out of more than $2.8 million.

According to court documents, Katrina Lynch, 39, of Cypress, owned and operated A Tender Heart, LLC, a company based in Midlothian. A Tender Heart was enrolled with the Virginia Medicaid Program as a Service Facilitator, a Medicaid provider that ensures Medicaid recipients receive needed and required services. Between 2011 and 2018, Lynch routinely submitted bills to Medicaid for services that her company never provided. For example, Lynch submitted bills to Medicaid for services supposedly provided to Medicaid recipients that had died, recipients that were hospitalized, recipients that transferred to other Service Facilitators, and recipients that had not been visited by any company employees for months.

Medicaid Fraud: https://www.fraudoftheday.com/medicaid-fraud/

 

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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.