A (not so) Caring Company

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Shot of a young nurse caring for a senior man in a retirement home

Fraud in the home healthcare fields appears to be on the rise as the industry grapples with a shortage of workers.

A woman in New Hope, Minn., who repeatedly billed the Medicaid program for work she never performed as a personal care assistant, recently pleaded guilty to Medicaid fraud that cost state taxpayers nearly $10,000.

According to court records, Kenya Razai Gordon, 34, billed Medicaid for home care support services she claimed to have provided to an elderly couple while she was working another job. These incidences happened while Gordon was supposed to be supporting the elderly couple in their home in 2014 and 2015.

While she was carrying out this Medicaid fraud scheme, she was working for a home care company, A Caring Company. A representative for A Caring Company admitted they had no idea Gordon was working another job at the time, and has since repaid all unauthorized payments back to the state’s Medicaid program. (What else could “a caring company do”?)

Gordon entered a guilty plea to one count of felony theft (of over $1,000) by false representation. Three other fraud charges were dismissed.

However, the court chose not to accept Gordon’s guilty plea and instead sentenced her to a stay of adjudication, which will be served as three years of supervised probation. The stay of adjudication means a felony conviction won’t be entered onto Gordon’s record if she successfully completes her probation program. (She should consider herself lucky, but let’s hope her home healthcare working days are over.)

According to a probable cause statement filed by the Attorney General’s Medicaid Fraud Unit, Gordon “submitted over 200 instances of overlapping claims” between her work under PCA provider, A Caring Company, and Coram Healthcare. (These companies may want to reconsider the employment of their claims staff). In one quarter of a year, Gordon exceeded 1,300 hours at both jobs, investigators said. That would have required her to work more than 14 hours a day, every day, for three months.

Today’s “Fraud of the Day” is based on an article, “Home health care worker gets probation in fraud case,” posted on KSTP.com on July 25, 2019.

A New Hope woman who investigators said repeatedly billed the Medicaid program for work she never performed as a Personal Care Assistance pleaded guilty and was sentenced Tuesday.

Court records show Kenya Razai Gordon, 34, entered a guilty plea to one count of felony theft by false representation – over $1,000. Her other charges of theft by representation – over $1,000 (aiding and abetting), theft by representation – public funds (aiding and abetting), and theft – medical costs (aiding and abetting) were dismissed.

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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.