Sitting Ducks

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19672596 - senior female woman patient in wheelchair sitting in hospital corridor with african american female nurse

The number of Americans who are 65-years-old and older are projected to more than double from today’s 46 million to more than 98 million by 2060, raising the age group’s share of the total population to nearly 24 percent. As this demographic group ages, it is more likely that these individuals will develop physical and mental issues that long-term care providers will have to address. Today’s fraudster duo from Slidell, Louisiana got a jump start on the aging population trend in the South when they worked together to carry out a $25 million Medicare fraud scheme that charged nursing home residents for psychological services that were unnecessary or never performed.

While many long-term care facilities are designed to address the medical needs of aging adults, the same emphasis is not always placed on the psychological needs of their residents. Not only do these facilities have to address physical limitations, they must also treat psychological needs that may include depression, anxiety, mental conditions, dementia or Alzheimer’s. (As you might guess, this is an area where nursing homes, family members and caregivers need to be vigilant, as they are fertile ground for fraud through unnecessary services and prescriptions.)

One of today’s fraudsters is a 63-year-old woman who owned a psychological services company registered for business in Louisiana, Mississippi, Florida and Alabama. Her partner in crime (who was also her son) owned a similar company where he was a licensed clinical psychologist in the same four states. Together, they contracted with nursing homes across the four-state territory to perform psychological testing services that nursing home residents didn’t need or even receive in many cases. (Over six years, the mother and son submitted more than $25.2 million in Medicare claims. Some were legitimate, but most were not.)

After a seven-day trial, both mom and son were convicted on one count of conspiracy to commit healthcare fraud and one count of conspiracy to make false statements related to healthcare matters. (Two other psychologists previously pleaded guilty in connection with the same scheme.) The mother was sentenced to seven years in prison and must pay $7.3 million in restitution, while her son received a sentence of 15 years behind bars and will have to pay back $13.8 million in restitution.

Nursing homes and long-term care facilities are sitting ducks for fraudsters. (Out of the $25.2 million in bogus claims submitted, Medicare paid more than $13.5 million before the scheme was shut down.) As the aging population grows, the number of healthcare fraud scams will most likely increase in sophistication and number. The best way to avoid healthcare billing scams like this one is to ask questions when billing notices don’t appear to be correct. Fraudsters are counting on patients and their caregivers to not notice the details. (Fortunately, the government does.)

Today’s “Fraud of the Day” is based on an article entitled, 2 Slidell residents sentenced in $25 million Medicare fraud scheme,” posted on NOLA.com on July 14, 2017.

Two Slidell residents who owned psychological services companies received long prison terms for their involvement in a $25 million scheme to defraud Medicare by charging for nursing home services that were unnecessary or never performed. Rodney Hesson was sentenced Thursday (July 13) to 15 years in prison and Gertrude Parker to seven years behind bars for health care fraud by U.S. District Court Judge Carl J. Barbier, according to the U.S. Attorney’s Office.

Hesson, 47, was also ordered by Barbier to pay $13.8 million in restitution. Parker, 63 was ordered to pay $7.3 million in restitution, according to a news release issued Friday.

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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.