Good Help is Hard to Find


When searching for home health caregivers, it can be hard for homebound individuals to find someone that is suitable. (Afterall, you would want to be comfortable with someone you don’t know coming into your home to take care of you. It’s a very vulnerable position to be in.) Fortunately, in many states, Medicaid allows qualified beneficiaries to select a family member to be their chosen caregiver. Today, we take a look at an Abilene, Kansas Medicaid beneficiary who selected her daughter to be her in-home caregiver. There was nothing wrong with that choice, but the daughter got into a bit of trouble for Medicaid fraud because she was actually in jail at the time her mother was submitting claims for her service.

The Medicaid beneficiary who chose her daughter as a personal care attendant was disabled. The mother billed the Kansas Medicaid program for 352 hours of personal care services supposedly provided by her incarcerated daughter. (She was actually serving time in prison for two previous drug convictions at the time.) Over 15 months, the daughter received $2,532.85 for her purported personal care services, which were not provided to her mother. (That leaves you wondering how the mom got along without any help while her daughter was in jail. Was she really that disabled, or did someone else help her out?)

The 29-year-old daughter pleaded guilty to Medicaid fraud and was sentenced to two years of probation with an underlying 16-month prison sentence. She was also ordered to repay the full amount she illegally collected in restitution. (I guess she thought the extra $7.19 per hour was worth a jail sentence.) The article also states that this type of sentence may block the daughter from being paid by a government healthcare program for a period of time. (How about never again?)

There doesn’t appear to be any punishment for the mother involved in today’s Medicaid fraud scheme even though she was the one submitting the falsified bills. (How could she not have known what she was doing was illegal? Perhaps her daughter misled her.) While the amount of benefits stolen in this case was not much, if every family caregiver did the same thing, Medicaid would run out of funds. (Fortunately, the Kansas Medicaid Fraud and Abuse Division had no trouble finding the right investigators to trace today’s illegal actions of this deceptive daughter.)

Today’s “Fraud of the Day” is based on an article,Kansas woman ordered to repay more than $2,500 for Medicaid fraud,” published by Little Apple Post on January 25, 2019.  

ABILENE – A Kansas woman was ordered Wednesday to repay more than $2,500 to the Kansas Medicaid Program after being found guilty of Medicaid fraud-related charges, according to Attorney General Derek Schmidt.

Ashley Loomis, 29, of Abilene, pleaded no contest in November and was found guilty in Dickinson County District Court of one felony count of making a false claim to the Medicaid Program and one felony count of conspiracy to commit making a false claim to the Medicaid Program.

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Larry Benson
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.