Less is Not More

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41913416 - medicaid torn newspaper headline on cash

Less is more when you declutter your home and unload your decades-old clothes and toddler toys of your college-age children. Less also was more when the owner of a durable medical equipment (DME) company in Edinburg, Texas, went almost six years before being caught committing Medicaid fraud(She caused her employees to dispense lower cost incontinence products to her customers, while billing Medicaid for more than $4.5 million in fraudulent claims.)

The owner of Compassionate Medical Supply (who wasn’t very compassionate) either submitted the fraudulent claims herself, or caused her employees to submit $4,536,152 in false claims to Texas Medicaid. She instructed her employees to dole out fewer and less expensive incontinence products such as pull-ons, youth diapers, and disposable underpads, but billed Texas Medicaid for a larger quantity of products at a higher price than was delivered by suppliers. The DME was either not properly provided to Medicaid recipients or not authorized by a physician. Due to her Medicaid fraud scheme, the government healthcare program suffered a loss of $3,143,149.41. (Who knew diapers could be so expensive for 100 Texas Medicaid beneficiaries.)

The 57-year-old McAllen, Texas, woman was ordered to serve 78 months in prison for healthcare fraud. When she pleaded guilty, the court dismissed two document fraud charges. She is expected to pay restitution of the $3.1 million to the Texas Medicaid program as part of her plea deal. (The more fraud the DME company owner commimtted, the more time behind bars and more money in restitution she will pay to make up for poor choices.)

Today’s “Fraud of the Day” is based on an article,Medical equipment company owner gets 78 months in federal prison,” published by Law Firm Newswire on October 28, 2019.

McALLEN — A federal judge sentenced a McAllen woman Tuesday to more than six years in prison for her role in a scheme to defraud Medicaid, according to a news release.

U.S. District Judge Randy Crane sentenced Anna Ramirez-Ambriz to a 78-month prison term during a sentencing hearing Tuesday, the release stated.

 

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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.