Gone, Just Like That

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Seventy-five years is a long time. A satisfying life could be lived over three-quarters of a century, but only if wise choices are made. While some people don’t have a choice in what happens to them, today’s fraudster did. The fraud spotlight shines on a Sugarland, Texas woman who made quite a few bad decisions that led her to commit Medicare fraud. (Unfortunately, her illegal acts have now secured a place for her behind bars for the next 75 years.)

The owner and director of nursing for a Houston home health agency defrauded Medicare of more than $10 million through the submission of fraudulent claims. (She had a little help from her husband and co-owner, as well as other staff members.)

For more than nine years, the woman and co-owner husband used Medicare reimbursements to pay illegal kickbacks to patient recruiters to refer patients to their home healthcare agency. The company also paid kickbacks to the Medicare beneficiaries for allowing them to bill for services that were not always medically necessary or provided. (Fraud cases involving large amounts of money such as this one rely on a web of co-conspirators to carry out the intricate scheme.)

The 53-year-old woman from Sugarland, Texas was convicted of Medicare fraud after a two-week jury trial. (She also got into trouble for trying to persuade a co-defendant to commit perjury.) She was sentenced to 75 years behind bars. (I bet that was a sobering experience when the judge delivered the bad news.)

Four others have also pleaded guilty to their part in the fraud scheme. The company’s former medical director was sentenced to time served along with three years of home confinement. One of the patient recruiters was sentenced to 33 months in prison, while another still awaits sentencing.

The co-owner’s husband is another matter. While the 53-year-old pleaded guilty to multiple counts of healthcare fraud, he also pleaded guilty to two counts of filing fraudulent tax returns. (Then he failed to appear for his sentencing.) So, the court sentenced him in absentia to 80 years in prison. (Court records show that he falsified medical records, ordered others to do the same, destroyed evidence, blackmailed a witness and tried to persuade a witness to commit perjury while in the federal courthouse.)

In an instant, the court changed the lives of this couple forever and their futures were gone, just like that. While in the prime of their lives, they made the wrong choice to defraud the federal government, the Medicare program and their victims. (Let this be a lesson to those who think it’s o.k. to steal government funds. It only takes a second to make the wrong choice, but a lifetime to suffer the consequences.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Owner of Home Health Agency Sentenced to 75 Years in Prison for Involvement in $13 Million Medicare Fraud Conspiracy,” released on August 11, 2017.

The owner and director of nursing of a Houston home health agency was sentenced today to 75 years in prison for her role in a $13 million Medicare fraud scheme.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, 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 and Special Agent in Charge D. Richard Goss of the Houston Field Office of IRS-Criminal Investigation Division (IRS-CI) 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.