Not Who She Appears to Be

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Stethoscope on 100 dollar bills symbolizing financial surveillance

Medicaid is a federal healthcare program that is meant to aid those with limited income and resources. Over 70 million Americans are currently covered by Medicaid. Low-income families, pregnant women, children, and individuals with disabilities are just a few of the groups qualified to receive Medicaid benefits through the Affordable Care Act.

American citizenship is a mandatory requirement to be eligible for Medicaid. Domincian national Martha Martinez Lara illegally entered the United States and obtained a stolen identity to fraudulently qualify for Medicaid. (There’s an old saying, ‘Don’t break the law while you’re breaking the law.’) Lara applied for benefits using the stolen identity while living in Providence, Rhode Island.

She applied for Medicaid in 2015 using a stolen identity, date of birth, and Social Security number. Lara was approved for coverage and received approximately $11,288.46 in aid from 2015 to 2019. (That amount will cover quite a bit more than a few eye doctor and dentist appointments.)

The stolen identity belonged to a woman in Puerto Rico who had never lived in or been to Rhode Island. Homeland Security determined the victim had no involvement in Lara’s scheme.  (That poor woman has endured not having voting rights, devastating hurricanes, and a stolen identity.)

Lara pleaded guilty in December 2019 to false representation of a Social Security number, aggravated identity theft, and healthcare fraud. She was sentenced in April 2020 to two years in federal prison and one year of supervised release. Lara must also pay $11,288.46 in restitution.

Here’s something to consider: while limited in options, there are programs that grant healthcare coverage to illegal immigrants. Basic primary care can be provided through community health centers and Title X clinics. Some of these clinics charge on a sliding scale providing affordable access to low income families. All hospital emergency rooms must legally provide basic emergency care regardless of immigration status.

The Department of Justice has stated that detecting and prosecuting those responsible for Medicaid fraud is a top priority as abuse of federal programs and taxpayer money will not be tolerated. You can report suspected Medicaid fraud through the U.S. Department of Health and Human Services’ website.

Today’s Fraud of the Day comes from a Department of Justice press release, “Dominican National Sentenced for Health Care Fraud, Misuse of a Social Security Number, ID Theft,” dated April 27, 2020.

PROVIDENCE – A Dominican national in the United States illegally, who admitted to fraudulently gaining access to Medicaid benefits with the use of a stolen identity and Social Security number, was sentenced today to two years and one day in federal prison.

Martha Martinez Lara, 48, previously admitted to the court that in August 2015, she applied for Medicaid benefits in Rhode Island using a stolen identity, date of birth, and Social Security number of another person. Lara’s application for Medicaid coverage was approved, and from approximately September 2015 through January 2019, she obtained RIte Care benefits totaling $11,288.46.

 

 

 

 

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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.