Caught Red-handed

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Close-up Of A Doctor's Hand Analyzing Report On White Desk

Medicaid is a government health insurance program that is meant to financially assist those who may not otherwise be able to afford healthcare coverage. While the intention of Medicaid is pure, the intentions of those looking to exploit it for their own financial gain are not. 

A Wisconsin woman from Sheboygan County has been charged with three counts of medical assistance fraud. Lori Kleinhans allegedly abused her position as a private nurse to defraud the state’s Medicaid program.

Kleinhans was hired as a private nurse in 2018 to provide care for a child and take him to his oncology appointments. The Wisconsin Department of Justice Medicaid Fraud Control Unit was informed that the child was regularly missing his appointments and began to investigate Kleinhans. (I’m glad someone was looking out for this kid because his nurse certainly didn’t appear to be.)

A surveillance camera was installed in the home of the child to monitor Kleinhans and her behavior. Kleinhans fraudulently billed the Wisconsin Medicaid program for 60 hours a week claiming that the child was under her constant supervision. The authorities actually discovered that Kleinhans was only at the house on five days between July 19 and August 7, 2018.

The surveillance camera revealed that Kleihans only visited the child between five and forty-one minutes on those specified days. The mother of the child claimed that Kleinhan had only missed one day of work while employed and never missed taking the child to his medical appointments. (You don’t have to be good at math to know that something isn’t adding up here.)

Despite the mother’s claims, surveillance footage and records both corroborated that Kleinhan was not consistently monitoring the child who was supposed to be under her care. (Sounds like the evidence against her is pretty solid.)

What is egregious about this alleged crime is that the child under the private nurse’s care missed 25 appointments at Children’s Hospital in Milwaukee. (So, what’s even worse than defrauding the Medicaid program is preventing a child from getting their cancer treatment.) 

Kleinhans is also accused of falsely billing Medicaid for 12 hours of work during the time she was a plaintiff in a trial. And if that were not enough, she was receiving Medicaid benefits even though she declared no one in her home was employed. (This is at the same time she was working as a private nurse and billing Medicaid.) If found guilty of medical assistance fraud, Kleinhan could face up to 18 years in prison.

Today’s Fraud of the Day comes from an article, “Sheboygan County nurse charged with Medicaid fraud,” published by WBAY.com on September 18, 2020.

SHEBOYGAN COUNTY, Wis. (WBAY) – A woman who worked as a private nurse in Sheboygan County is charged with three counts of medical assistance fraud. Lori Kleinhans, 62, of Adell, faces up to 18 years in prison if she’s found guilty.

The Wisconsin Department of Justice (DOJ) Medicaid Fraud Control Unit investigated the case. According to the criminal complaint:

A child Kleinhans was supposed to be providing care for in 2018 was repeatedly missing medical appointments. It was brought to the attention of authorities, and a surveillance camera was installed to watch the house. Kleinhans was only seen at the house on five days between July 19 and August 7, visiting once or twice a day, with visits lasting as little as 5 minutes and no longer than 41 minutes. Kleinhans was consistently billing Medicaid for 60 hours a week and reporting she was giving the child constant supervision.

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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.