One for the History Books

26578311 - male nurse pushing stretcher gurney bed in hospital corridor with male & female doctors & nurses & senior female patient in a wheelchair

It’s important to learn about history because it helps us to not repeat the mistakes that others have made. Today’s “Fraud of the Day” is heralded as one that will go down in history as perhaps the largest home healthcare fraud scheme ever accomplished to date.

A 65-year-old man (who at such an advanced age should have known better) and his cronies participated in a scam that stole nearly $400 million from Medicaid and Medicare. (Even his three co-defendants, who ranged in age from 54 – 59, were old enough to know what they were doing was wrong, yet they participated in this large-scale, sophisticated healthcare fraud scheme anyway.) They used four companies they owned or controlled to carry out the massive healthcare benefits heist.

Here’s how they did it. Today’s fraudster and two other co-defendants recruited Medicare beneficiaries to fraudulently sign up for home healthcare services by going door-to-door. One co-conspirator, who was a nurse, bribed residents at a homeless shelter to visit her van outside the location with free McDonald’s meals. (Be careful when offered a free meal from a fast food restaurant in exchange for your healthcare identification information. The meal may not make you very happy in the end.)

Once today’s fraudster, the nurse and other co-conspirators were able to get the prospective patients to sign on the dotted line declaring that they needed home health services, fraudulent documents and fake care plans were then prepared to make it appear that they did indeed need those medically unnecessary services.

One of those assisting in the scam was a doctor, who was the final approver for those unneeded services. The doctor had a staff dedicated to helping certify the fake care plans for thousands of patients. (Apparently there was a separate room set aside just for stamping fraudulent signatures and certifications.) Once the patient care plans were certified by the doctor, today’s fraudster and others helped to create fake notes to make it look like skilled nursing services were being provided to the patients. (The doctor even made visits to the patients to make the scam look authentic.)

The lid got blown off this scheme when a federal data analysis indicated that the doctor had submitted unique Medicare claims for 11,000 patients. (This is way more than any normal doctor would do. He ran up a bill of $374 million to be exact between the two government healthcare programs.)

Today’s fraudster received a sentence of more than 17 years in federal prison and must pay restitution of $23,123,897.18 to Medicare and $506,880.08 to Medicaid. Three of his co-conspirators were convicted of conspiracy to commit health care fraud and health care fraud following a six-week long trial. They are awaiting sentencing.

The punishment for the criminal in today’s article is significant and serves as a warning. Let’s hope other would-be fraudsters are history buffs who pay attention to this case’s outcome.

Source: Today’s “Fraud of the Day” is based on an article entitled, Owner of Dallas Health Care Company Gets 17 Years in Federal Prison for Role in Huge Fraudpublished by Dallas Observer on June 14, 2017.

U.S. District Judge Sam Lindsay sentenced the owner of a Dallas home health care company to 17 years in federal prison Tuesday for his role in what authorities have called the biggest instance of home health care fraud in the history of Medicare and Medicaid. Lindsay also ordered Wilbert James Veasey Jr., 65, to pay more than $23 million in restitution to Medicare and more than $506,000 in restitution to Medicaid.

According to federal prosecutors, Veasey and his co-defendants, Jacques Roy, Cynthia Stiger and Charity Eleda, “engaged in a large-scale, sophisticated health care fraud scheme in which they conspired together and with others to defraud Medicare and Medicaid through companies they owned/controlled: Medistat Group Associates, P.A., Apple of Your Eye Health Care Services, Inc., Ultimate Care Home Health Services and Charry Home Care Services.”

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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.