Failed Leadership

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Common characteristics possessed by great leaders include honesty, integrity, confidence, and the ability to delegate and empower others. Today’s fraud article examines the actions of a prominent leader at two Houston, Texas-based home care businesses. While the former Director of Nursing and Administration may have been confident in her abilities to delegate and empower others to falsify medical records so she could collect $20 million in a Medicare fraud scheme, she was definitely lacking in the areas of honesty and integrity. Because of her failed leadership tactics, she’s now headed to prison.

To be considered a good leader, one should obviously not do anything illegal on behalf of the company they work for. The former director from Pearland, Texas conspired with others to submit fraudulent claims involving home health services. (It’s safe to say that this lady is a bad leader.) For approximately eight years, the services she claimed on behalf of the company she worked for were either not medically necessary, not provided, or both.

Evidence presented in court showed that the former Director falsified patient records to make patients appear to be homebound when they were not. (That means that the home health services she billed Medicare for did not qualify for payment.) She also paid recruiters to refer Medicare beneficiaries to the two companies she worked for and paid doctors to approve false plans of care for Medicare beneficiaries.

After a four-day trial, the former 54-year-old Director from Pearland, Texas was found guilty of healthcare fraud. Her punishment is a decade in prison for her role in the $20 million Medicare fraud scheme.  She is also required to pay Medicare restitution in the amount of $20,462,607.21.

Congrats to the Medicare Fraud Strike force for leading the effort in shutting down this illegal operation. Investigators teamed together to confidently seek the truth in this case, delegating the investigation to multiple agencies who were empowered to stop fraud in its tracks. Truly, an inspiring example of many great leaders in their respective government agencies who are passionate about protecting vulnerable citizens and American taxpayers. (Now that’s what I call great leadership.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, Former Administrator of Two Houston Home Health Companies Sentenced to Prison in $20 Million Medicare Fraud Scheme,” released on April 4, 2019.  

The former Director of Nursing and Administration of two Houston, Texas-based businesses was sentenced today to 10 years in prison for her role in a $20 million Medicare fraud scheme involving false and fraudulent claims for home health services.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Dallas Region made the announcement.

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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.