Watch Out for Lemons

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52342343 - nurse taking care of sick elderly patient at home

As the nation’s population continues to grow, many elderly people prefer to be cared for in their own home. The U.S. Bureau of Labor Statistics reports that the demand for home healthcare aids is growing rapidly, which is good for folks who are looking for a job, but buyer beware when vetting potential companies for home health services. (In some states, it seems that anyone can hang out a home healthcare shingle without much training.) Where there is quick growth in a particular job area, there’s also the potential for fraud. A couple from Hilliard, Ohio used their home healthcare company to commit Medicaid fraud, and used the illegally gained proceeds to live a lavish lifestyle.

The State of Ohio is one of a handful of states that do not license home healthcare agencies. This raises questions around the legitimacy of the home healthcare companies and the employees who provide the in-home care. (Wouldn’t you want to make sure that the health aide providing care was qualified and certified to perform their duties?)

The couple who owned the home healthcare company at the center of today’s article fabricated previous work experience for their aides by listing jobs and training that never occurred to make it appear that their employees were qualified to provide home health services. The owners instructed their employees to falsify patient medical records so they could charge for procedures that their patients were not qualified to receive. The employees were also told to submit time sheets and bogus bills to Medicaid. (Over approximately three-and-a-half years, the company submitted $1 million in fraudulent Medicaid claims.)

It’s important to note that before the couple launched the home healthcare company, the wife was a nurse, while the husband worked as a car salesman. (He also had a criminal history involving cocaine trafficking, liquor sales to minors, along with other criminal mischief.)

In court, the 52-year-old Ohioan took full responsibility for his illegal acts. The man and his 50-year-old wife pleaded guilty to Medicaid fraud and money laundering. (They used the stolen Medicaid funds to build a $932,000 luxury home and live a lavish lifestyle.) The man received a sentence of four years behind bars, while the wife was sentenced to three years of probation for her role in the fraudulent scheme.

As part of a plea agreement, the couple sold their luxury home, netting $561,557. (They will have to come up with an additional $33,000. The wife gets to immediately start paying nominal payments and the husband will finish paying the debt off after he is released from prison.)

This fraud case raises the important issue of being vigilant when choosing a home healthcare provider. It also reinforces the idea that Medicaid beneficiaries should check their provider statements to make sure that the government healthcare program is being properly billed for services provided. This former car salesman may have sold a few lemons in his time, but the government didn’t fall for this scam. Instead, the government made lemonade from this sour situation by protecting taxpayers and Medicare beneficiaries from any additional fraud.

Today’s “Fraud of the Day” is based on an article entitled, Hilliard area husband and wife sentenced for Medicaid fraud, money laundering,” published by The Columbus Dispatch on September 14, 2017.

A Hilliard-area man who used his home-health company to defraud Medicaid and build a $932,000 luxury home apologized for his crimes as he was sentenced Thursday to four years in prison.

“I do take full responsibility for my acts,” Riyad Altallaa, 52, told Chief U.S. District Judge Edmund A. Sargus Jr. in federal court in Columbus.

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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.