Not a Coincidence


The State of Idaho allows family members to be paid by Medicaid to provide personal care to their loved ones. After Medicaid beneficiaries hire their family member, the caregiver must submit timesheets to the government healthcare program to be paid. A Canyon County, Idaho man was the designated caregiver for his adopted son. While there was no problem with this by law, he committed Medicaid fraud by claiming he provided personal care services for his son over a 10-month period when they were estranged.

The father acted as a caregiver through Idaho’s Consumer Direct Care Network, which serves and supports people with disabilities by helping them to remain safe, healthy and independent in their own homes. The man served as his son’s community service worker and claimed he assisted him with life tasks including job hunting and relationship building. (There’s just one problem. His son was not living with him during the time he claimed he provided these personal care services.)

Despite the 10-month period of estrangement, the man billed Medicaid for services he did not provide to his son. He even filed a report with the local police stating that he had not heard from his son during that time, yet he billed the government healthcare program anyway. (Did he not think that someone would eventually check out his story and put two and two together? Or maybe I should say ten months and ten months together. This was not a coincidence.)

Investigators determined that the 44-year-old father ultimately stole about $13,000 in Medicaid payments he did not deserve. He pleaded guilty to one count of Medicaid fraud and was sentenced to five years in prison, but the judge suspended the sentence and gave him three years of probation following ten days in jail. He was also ordered to pay $13,205 in restitution, a $1,000 fine and complete 80 days of community service.

A coincidence is a remarkable occurrence of simultaneous events without an apparent connection. It was not a smart move for this defrauding father to bill Medicaid for services he did not provide during the time he reported his son missing. The connection between these two events was definitely not a coincidence, it was fraud.

Today’s “Fraud of the Day” is based on an article entitled, Canyon County man gets three years of probation for fraudulent Medicaid billing,” published by Idaho Press-Tribune on June 21, 2017.

A judge has ordered a Canyon County man to complete three years of probation as part of his sentence for stealing approximately $13,000 in Medicaid payments by illegally billing Idaho for medical services regarding an adopted son.

According to the Idaho Office of the Attorney General, 3rd District Judge Gene Petty sentenced John D. Bone, 44, to five years in prison Tuesday on one count of provider fraud, but suspended that underlying sentence, instead imposing probation.

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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.