Practical Nurse, Impractical Fraud

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A recent pair of reports by the Rochester Democrat & Chronicle detail a licensed practical nurse in upstate New York who exploited a special needs patient to cheat the state Medicaid program of nearly ten thousand dollars’ worth of payments for services she did not provide.

According to the reports, the New York State Attorney General’s Medicaid Fraud Control Unit peeled back the layers on the Medicaid fraud, after it pored through documentation kept by the Medicaid Fraud Inspector General. A subsequent review of financial and cell phone records, along with a series of interviews, brought forth allegations that the private-duty nurse intentionally stole from the state’s Medicaid program when she charged it for 42 extra hours of care – totaling $8,838.00 in false billings – over four months. (So this supposed caregiver pursued a passion-profession, and then proceeded to financially drain the programs that supported her job? Alas, I digress.)

Six months later, the nurse was formally charged with nine felonies that together carry a maximum penalty of up to seven years in the state penitentiary. All but one of the charges were for multiple counts of defrauding New York’s Medicaid program, by knowingly offering a written instrument containing false information in the first-degree. The other was for third-degree grand larceny, as the alleged extent of her theft far exceeded $3,000.00.

The nurse ended up pleading down to a misdemeanor charge of Petit Larceny, more commonly known as ”petty theft.” (Call me preachy, but ”petty” doesn’t quite cover the ethical transgressions I associate with this type of ”caregiving.”)She was further sentenced to three years’ probation and ordered to repay the stolen $8,838.00. (We hope the state tacked on an interest rate on par with that of Medicaid penalties.)

A compromised physical or mental capacity is what makes people become patients, and a caregiver’s effectiveness hinges on established trust with whom they’re tending. Duping the government certainly is risky and illegal, but capitalizing on a patient’s disadvantaged state to collect funds intentionally allocated for their needs is beyond the pale.

Source: Today’s ”Fraud of the Day” is based on ”LPN pleads guilty in Medicaid case” and ”LPN to pay back state in Medicaid fraud case,” two Rochester Democrat & Chronicle reports by Patti Singer published on November 3, 2015 and January 5, 2016, respectively.

Schmeka Morgan, 34, of Rochester, faces three-years of probation and repayment of $8,838 to the state. The plea was entered Monday in Brighton Town Court.

Morgan had been charged with one count of third-degree grand larceny, a felony, and eight counts of first-degree offering a false instrument for filing, also a felony.

The complaint alleged that Morgan, working as a private duty nurse for a young adult with special needs, falsely billed for 42 hours of services on eight days from Dec. 25, 2014 to March 29, 2015. She was accused of stealing $8,838 from 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.