A Not So Tender Heart

Calculator and stethoscope on paperwork

Some people are called to the medical field because of their endless compassion and desire to care for people. Others work in the medical field because of their greed and the opportunity to exploit others.

Katrina Lynch of Cypress, Virginia used her position in the medical field to take advantage of the system and the people she was supposed to serve. Lynch owned and operated a medical company that defrauded Medicaid of millions of dollars.

Lynch’s company, A Tender Heart, was a Service Facilitator through the Virginia Medicaid Program. A Service Facilitator is enrolled as an independent Medicaid provider or as an employee of a Medicaid-enrolled Services Facilitation company. (Lynch didn’t have a tender heart, but a hard heart. The only thing her heart was set on was making lots of money at the expense of her victims.)

Service Facilitators assist patients in using medical devices, partake in home wellness visits, and help provide care to those in need of assistance.  (Fraudsters now conveniently come to your home.) A Tender Heart was entrusted to provide Medicaid beneficiaries with the medical equipment and services that they needed. (I would not recommend entrusting them with your checkbook.)

Bills were fraudulently submitted to Medicaid for services never provided between 2011 and 2018. These fraudulent billings include allegedly providing services to beneficiaries that were deceased, hospitalized, had changed Service Facilitators, or were no longer in need of services. This scheme cost the Virginia Medicaid Program more than $2.8 million dollars.

Lynch pleaded guilty in July 2020 to one count of healthcare fraud. She is scheduled to be sentenced on December 1, 2020. The maximum penalty for healthcare fraud is 20 years in prison. (Fortunately for Lynch, the prosecutors have not asked for the maximum sentence in this case, but it’s a good guess that she will also be ordered to pay some form of restitution.)

Each state has a Medicaid Fraud Control Unit that investigates and prosecutes Medicaid fraud. Their goal is to ensure that there is no patient abuse in healthcare facilities or fraudulent billing practices occurring. To file a formal fraud complaint, contact your state’s Office of the Attorney General’s website.

Today’s Fraud of the Day comes from a Department of Justice press release, “Owner of Virginia Company Pleads Guilty to $2.8 Million Medicaid Fraud,” dated July 7, 2020.

RICHMOND, Va. – A Texas woman pleaded guilty today to defrauding the Virginia Medicaid Program out of more than $2.8 million.

According to court documents, Katrina Lynch, 39, of Cypress, owned and operated A Tender Heart, LLC, a company based in Midlothian. A Tender Heart was enrolled with the Virginia Medicaid Program as a Service Facilitator, a Medicaid provider that ensures Medicaid recipients receive needed and required services. Between 2011 and 2018, Lynch routinely submitted bills to Medicaid for services that her company never provided. For example, Lynch submitted bills to Medicaid for services supposedly provided to Medicaid recipients that had died, recipients that were hospitalized, recipients that transferred to other Service Facilitators, and recipients that had not been visited by any company employees for months.

Medicaid Fraud: https://fraudoftheday.com/medicaid-fraud/


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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.