From Exclusive to Excluded

Young experienced psychotherapist making a notes

There are many benefits to joining a club. Club membership can open up new avenues for meeting new people, learning new skills, and advancing careers. Today, we learn about a woman from Mount Pleasant, South Carolina who was a member of the “Fraudster Club” when she got caught carrying out a $2 million identity theft and healthcare fraud scheme. (After her case went to court, she also became a member of the “Convicted Club.”)

The former speech therapist covered up the fact that she owned and controlled two businesses that provided services to Medicare and Medicaid beneficiaries. Over five years, she submitted claims to both government healthcare programs for speech therapy services that were provided by different speech therapists than indicated on the claims. (In some cases, the services were not rendered at all.) During a four-day trial, the jury reviewed evidence that proved she also submitted claims for beneficiaries who were deceased. (As you can imagine, her victims didn’t have much to say about it.)

The back story is that this offense was not the first for the speech therapist. She had previously pleaded guilty to healthcare fraud and was banned by the U.S. Department of Health and Human Services from submitting fraudulent Medicaid and Medicare claims. (Obviously, that didn’t stop her from doing it again, even though she had been excluded from participating in federal healthcare programs forever.)

The 44-year-old fraudster was ultimately found guilty of aggravated identity theft and healthcare fraud. The Mount Pleasant resident was sentenced to more than nine years in federal prison for carrying out the scheme that stole more than $2 million from American taxpayers. After serving time behind bars, she will be subject to three years of court-ordered supervision and must pay $580,937.44 in restitution.

There are definitely benefits to club memberships. (Such as secret handshakes, hotel points, fine dining, vacations around the world and such.) While today’s fraudster may have initially reaped monetary benefits from her criminal scheme, those benefits have now been revoked. Where she is headed, the club initiation process is going to be brutal. (But, one benefit is that she’ll have plenty of time to reflect on why she is there.)

Today’s “Fraud of the Day” is based on an article entitled, “Former Mount Pleasant speech therapist gets 9-year prison sentence for fraud scheme,” published by The Post and Courier on November 28, 2018.

A former Mount Pleasant speech therapist who filed nearly $2 million worth of phony health care claims with the federal government over a five-year span was sentenced Wednesday to nine years in prison.

Following a four-day trial argued by the S.C. Attorney General’s Office and the U.S. Attorney’s Office in July, Gena Randolph, 44, was convicted on one count each of health care fraud, aggravated identity theft and three counts of making false statements related to health care matters, prosecutors said.

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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.