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While today’s fraudster may have initially reaped monetary benefits from her criminal scheme, those benefits have now been revoked.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, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.