Don’t Throw Caution to the Wind

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52342343 - nurse taking care of sick elderly patient at home

If I’ve said it once, I’ve said it a thousand times. When looking for a home healthcare aide, make sure you properly vet the candidates before choosing the best one for your situation. A home healthcare worker from Rochester, New York was assigned to take care of a Medicaid beneficiary, who had significant disabilities, at their home in Geneva, New York. But, instead of providing the expected level of care, he committed Medicaid fraud by submitting false claims to the government healthcare agency. (He never provided the services at all. Oh, and by the way, he also had two prior felony convictions.)

 The Medicaid beneficiary qualified for 116 hours of personal care each week. (That adds up to about 16 ½ hours per day.) The patient had significant healthcare needs, including tube feeding and seizure monitoring.

The healthcare worker submitted bogus timesheets to his employer. The Medicaid beneficiary signed off on the phony time sheets confirming that the aide had performed daily personal care services, even though that was not true. (That makes me wonder if the relative was in on the scam or perhaps the aide forged the relative’s signature. The article does not say one way or the other.)

Over three months, the New York healthcare aide stole more than $6,000 from Medicaid and robbed the disabled recipient of the home care services they qualified for and deserved. The New York State Attorney General’s office opened an investigation into the matter and found that the aide was not present to provide the services he claimed. (He can thank his ankle monitor device for clearing up any doubts regarding his whereabouts.)

It turns out that the New York healthcare aide was on parole for two prior felony convictions during the time frame he submitted the false claims to Medicaid. He had a prior conviction for Criminal Possession of a Weapon in the Third Degree and Criminal Possession of a Controlled Substance in the Fourth Degree. (Is that someone you’d like to have taking care of a vulnerable loved one? I think not.)

Overwhelming evidence linked to the data retrieved from the fraudster’s ankle monitoring device showed that he was 40 miles away in Rochester during the time he claimed to be providing services in Geneva. (Busted! It’s kind of hard to argue with that fact.)

The investigation, which was conducted by the Medicaid Fraud Control Unit, led to the conviction of the New Yorker. After confessing to submitting false timesheets to his healthcare company for services not provided, he pleaded guilty to Medicaid fraud. He was sentenced to one-and-a-half to three years in state prison for improperly billing Medicaid for $6,261.80 in services not rendered.

As I mentioned in the beginning, it’s really important to choose a home healthcare provider that you can trust. Don’t’ just throw caution to the wind, but check out these tips to protect your loved ones. These suggestions will help you to avoid poor home healthcare experience and perhaps prevent healthcare fraud at the same time. (Your loved one and the government thank you in advance for your attention to detail.)

Today’s “Fraud of the Day” is based on an article entitled, Rochester man sentenced to prison for faking Medicaid timesheets,” posted on 13wham.com on November 10, 2017.

ROCHESTER, N.Y. (WHAM) – A Rochester man was sentenced Thursday after he pleaded guilty last month to taking thousands of dollars in wrongly-billed Medicaid money.

Nicholas Rice pleaded guilty on October 5 to one felony count of first-degree falsifying business records.

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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.