Bad Behavior

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47310150 - woman doctor with stethoscope and currencies dollar, paying for medical care, corruption or bribe concept

People have all sorts of reasons for behaving badly. Some are placed in difficult situations and feel there is no way out. As a result, frustration can turn into anger and subsequently emotions erupt, impacting others in a negative way. Others feel entitled to behave badly because of selfish reasons and they generally don’t care how their behavior impacts others. (Fraudsters usually fall into this category.) An article published by The Clarion-Ledger tells about a woman whose bad behavior enabled her to bilk the Medicaid program out of hundreds of thousands of dollars before being caught.

The woman at the center of this article not only behaved badly by stealing money from Medicaid, but she was also a bad actor. While acting as medical director of a hospice care company, she certified patients for hospice while only qualified to be a physician’s assistant. (Hospice care is designed to support people during the end stage of a terminal illness by making patients comfortable and free of pain. The question is whether or not she was acting in the best interest of her patients. Was she really qualified to decide who received hospice care?)

The fake medical director billed Medicaid for patient visits even though her physician’s assistant license was suspended. (That’s pretty scary. I wonder why her license was suspended. Did she forget to renew it? Did she fail to perform her duties correctly? Did she endanger the life of one of her patients?) Further research revealed that the bad actor bilked Medicaid out of more than $300,000 through her fraudulent scheme while pretending to be a licensed physician’s assistant.

The 46-year-old woman pleaded guilty to three counts of Medicaid fraud. She was sentenced to 11 years in jail. She is required to serve five years while the remaining six are suspended. In addition, she will serve five years’ probation. The fraudster was also ordered to pay more than $803,000 in restitution, a penalty of more than $2.4 million, a $1,000 fine and $500 to the Victim’s Compensation Fund. (That sentence ought to suffice. Good job, judge!)

End of life issues can be pretty emotional for family members who want the best care available for their loved ones. This woman’s selfish actions most likely prevented many deserving Medicaid beneficiaries from receiving care and comfort at the end of their lives. Now it’s this fraudster’s turn to be uncomfortable while serving out her sentence. (Maybe she’ll gain more empathy for others while paying her dues behind bars.)

Source: Today’s ”Fraud of the Day” is based on an article entitled ”Ridgeland Woman to Pay 3 Million in Medicaid Fraud” published by The Clarion-Ledger on June 30, 2015.

A Ridgeland woman has been ordered to pay more than $3 million in restitution and penalties after she pleaded guilty to three counts of Medicaid fraud.

Theresa Lane Fisher, 46, was ordered Monday to pay $803,744.93 in restitution and a penalty of $2,411,234.79.

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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.