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Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Fraudsters are everywhere just waiting to find vulnerabilities to exploit in the lives of their unsuspecting victims. Today’s fraudster is an Idaho woman who worked as an officer manager for a skilled nursing facility in Boise for many years without anyone suspecting that she was a fraudster. (Fraudsters are chameleons who appear to live normal lives but adapt their persona to fit their environment.)

Karina Renee Moore served as the office manager of Shaw Mountain of Cascadia, originally Marquis Care of Shaw Mountain, for more than nine years. Evidence led investigators to discover that Moore had been defrauding residents of the nursing facility since January 2010.

For the last six years of her employment at the facility, Moore embezzled social security and private payments from the financial accounts of residents, who had no current source of income aside from their social security benefits. (She preyed on the naivete and vulnerability of the elderly she was supposedly looking out for.) 

It’s no surprise that Moore was terminated from her position for embezzling nearly $24,000 from the nursing facility. (While there wasn’t an uprising with tiki torches and pitchforks, the residents couldn’t have been happy to discover they’d been scammed.)

Moore also collected social security payments before the funds reached residents’ accounts, including a former resident who was deceased. (Moore better not believe in ghosts, because this is a haunt-worthy offense.) Other schemes Moore conducted include fraudulently billing Medicaid for services that had already been covered through other health benefit programs. This resulted in thousands of dollars in over payments and reimbursements. (And, you know she pocketed those government benefits.)

The estimated loss suffered due to Moore’s fraudulent schemes totaled $611,860. Moore pleaded guilty to healthcare fraud charges on January 7, 2020. She was sentenced to 37 months in federal prison and is to serve three years of supervised release. She’ll also have to pay back $611,860.86 in restitution.

If you suspect fraud or abuse within a long term care facility call the Office of Inspector General’s tipline at 1-800-447-8477 or submit a tip online.

Today’s Fraud of the Day comes from a Department of Justice press release, “Eagle Woman Sentenced to 37 Months for Health Care Fraud,” dated May 29, 2020.

BOISE – Karina Renee Moore, 48, of Eagle, was sentenced to 37 months in federal prison for health care fraud, U.S. Attorney Bart M. Davis announced today.  U.S. District Judge B. Lynn Winmill also ordered Moore to serve three years of supervised release following her release from prison and to pay $611,860.86 in restitution.  Moore pleaded guilty on January 7, 2020.

According to court records, from August 2007 to December 2016, Moore was employed as the office manager at a skilled nursing facility in Boise.  The skilled nursing facility was originally Marquis Care of Shaw Mountain, but it was sold in May 2016 and renamed Shaw Mountain of Cascadia.  On December 1, 2016, employees at Shaw Mountain of Cascadia called law enforcement after discovering checks showing that the defendant had embezzled $23,805.66.  The resulting investigation revealed Moore had been defrauding the Shaw Mountain care facility since at least January 2010.  Between January 2010 and December 2016, Moore defrauded health care programs and social security programs, resulting in a loss of $611,860.86.

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