Home-Health Fraud

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People who qualify for Medicaid’s home healthcare coverage are some of the most vulnerable among us. They are impoverished or disabled and count on home-health workers to help them with basic needs. But that doesn’t stop some people from stealing from the program and not giving patients services they are due.

That’s the case with a Pennsylvania-based fraud ring where a seventh person has pleaded guilty to defrauding the commonwealth’s Medicaid program.

The 48-year-old Pittsburgh woman is among 16 home healthcare workers indicted on charges of defrauding the system of about $80 million.

For her part, the woman pleaded guilty to defrauding the program of about $70,000. (Guaranteed she’ll have to pay that back). The woman was involved in the conspiracy from January 2011 through April 2017 when she fabricated time sheets for four home-health companies she worked for during that time, federal prosecutors said. She is scheduled to be sentenced in March.

The defendants submitted fraudulent claims for services that were never provided to the consumers identified on the claims, or for which there was insufficient or fabricated documentation to support the claims, prosecutors said.

Pennsylvania loses millions of dollars each year by paying for fraudulent claims, according to the Medicaid Fraud Hotline (888-742-7248). The state now offers rewards of more than $1 million to those who report potential fraud to its hotline.

Today’s Fraud of the Day is based on the article, “7th defendant pleads guilty in alleged $80 million Medicaid fraud case,” published by The Tribune-Review on Nov. 26, 2019.

A Pittsburgh woman pleaded guilty to federal charges of Medicaid fraud and conspiracy.
Tionne Street, 48, was accused of defrauding Medicaid for about $70,000 and was one of about 16 people who were indicted on the alleged conspiracy involving about $80 million in overall fraud.

Street is the seventh person to enter a guilty plea.

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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.