Healthcare Fraud Boom

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A young girl and her mother are in a doctor's office. The daughter is holding a stuffed teddy bear. They are happily talking to their doctor.

It’s no secret that healthcare costs are skyrocketing. Instead of turning to assisted living facilities or nursing homes, many individuals are now relying on home healthcare services to keep costs lower. The U.S. National Library of Medicine reports that as of this year, individuals over the age of 65 years will outnumber those under the age of five. This statistic is foreboding because while government healthcare programs are onboard with helping Americans to age with dignity at home, you and I both know that this is a perfect opportunity for a healthcare fraud boom. (Criminals rarely turn down a chance to steal benefits they don’t deserve.)

Today’s fraudster is a Nottingham, Maryland home healthcare provider who was hoping to take a free ride on the government by claiming he was providing home healthcare services when he was actually taking trips. While working for an area home healthcare company, he submitted claims stating that he was caring for two wheelchair-bound Medicaid beneficiaries who had HIV. What he really did was stick the government with a bill for several trips to Atlanta, Boston and Puerto Rico. (Wouldn’t it be wonderful to receive a free vacation from the government each year? Apparently, this fraudster thought this was one of the benefits he should receive.)

Instead of providing in-home personal care services to his assigned patients, he was most likely sightseeing, eating out at restaurants, dressing himself in a swimsuit and applying sun tan lotion several times a day. (This was a totally different idea of home-based personal care services.) Over nearly four years, the home healthcare provider falsely claimed more than 150 times that he was taking care of his patients.

The 41-year-old man was convicted of felony Medicaid fraud for lying to the government healthcare program. He received a sentence of five years in prison, suspended and three years of probation. He also has to pay back $32,000 in restitution to Medicaid. (He’s not allowed to leave the state of Maryland without prior authorization. That will definitely put a cramp in his vacation plans.)

Today’s “Fraud of the Day” is based on an article, “Nottingham Man Convicted of Medicaid Fraud After Pretending to Care for Patients When He Was Actually On Vacations,” posted on Baltimore.CBSLocal.com on August 26, 2019.

BALTIMORE (WJZ) — A 41-year-old man was convicted of felony Medicaid fraud related to the care of two wheelchair-bound Medicaid beneficiaries living with HIV.

Mark Wilkerson was sentenced to five years in prison, all suspended, with three years probation, and ordered him to pay more than $32,000 in restitution to the Medicaid program.

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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.