Dead as a Door Nail

65037362 - healthcare cost concept with calculator and medical bill

There are many ways to commit healthcare fraud. Some of the most common methods include billing for services not rendered, double billing, misrepresenting dates, locations and providers of service, charging for more expensive procedures, but providing less expensive ones and paying kickbacks. Today’s fraudster, the owner of a medical equipment company in West New York, New Jersey, committed Medicaid fraud through fraudulent billing practices, but with a twist. He billed the government health care program for medical supplies that were never provided to patients, because they were deceased.

Today’s article explains that this Clifton, New Jersey resident was associated with Medicaid fraud prior to the current offense. His company, which was previously owned by someone else, was involved in a scheme that caused Medicaid to be overbilled by $33,840 through the submission of 200 inflated claims. (That’s probably where he came up with the idea to fraudulently bill Medicaid once he owned the medical equipment supply business.) Fast forward about a decade and this New Jersey man is back in the fraud limelight again.

For more than eight years, the medical equipment company owner masterminded his own scheme to submit bogus claims totaling more than $100,000. He billed Medicaid for compression stockings, diapers and other supplies that were purportedly provided to people who were alive. (But, as you know they were dead as a door nail.)

Billing deceased people for services not rendered eliminates the problem with customers reporting that they were scammed. (That was certainly creative.) However, that doesn’t eliminate the problem of the government eventually discovering the scam, it just takes a little longer to detect. (And, that’s what today’s fraudster was counting on.)

The 43-year-old man from New Jersey pleaded guilty to Medicaid fraud. He’s now headed to state prison for four years and will have to pay $101,000 in restitution to the Medicaid provider he scammed. The fraudster also consented to being barred for life from participating as a provider in the New Jersey Medicaid program. (It looks like this man’s master plan to steal from New Jersey’s most vulnerable citizens is now dead on arrival with absolutely no chance of resuscitation.)

 Today’s “Fraud of the Day” is based on an article entitled, Why owner of medical supplies company is heading to prison,” posted on on January 26, 2018.

For the better part of a decade, Alfredo Valdes Jr. billed Medicaid more than $100,000 for medical supplies he distributed to patients, some of the state’s most vulnerable citizens.

His patients, however, had no use for those supplies – they were already dead.

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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.