Fraud Prosecuting Machine

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Medicaid fraud was running rampant until a federal task force was formed in 2008 to stop fraud within the government health care program. Fortunately, it didn’t take long for the task force to get up to speed and now criminals who once found it easy to steal from the government are now up against a fraud-prosecuting machine. Today’s story describes the successful prosecution of three former home health care providers, who are now headed to prison for committing home health care fraud.

Home health care fraud usually occurs when workers falsify documents and request reimbursement for services that are either unnecessary or not prescribed by a physician. Also, as in this particular case, fraudsters commonly charge the government for services that were never provided.

Today’s ”Fraud of the Day” covers five defendants who submitted fake documentation over a four-year period to Medicaid for the purposes of becoming an accredited home health care provider. (They also forged documents to make it look like doctors had approved their suggested patient care plans, and submitted bills for services that were never provided to patients.)

Four out of the five defendants were sentenced for their roles in the Medicaid scam that bilked the government health care program out of $3.4 million. The first fraudster to be sentenced prior to this case was a female. She received probation. Three men received prison terms of 46 months, 37 months and 27 months, respectively. (One of the men recruited patients by paying cash kickbacks.) Another defendant’s fate remains to be seen when sentenced. All five of the defendants agreed to forfeit $400,000 and will pay restitution.

Congratulations to the investigators in this case and the federal fraud prosecuting team who have put an end to this very common crime. These fraudsters won’t be heading to any homes in the future to victimize any more patients. Their new home is going to be behind bars in prison for the foreseeable future.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Three Ohio Home Care Workers Sentenced for Fraud,” posted on homecaredaily.com on December 23, 2016.

In a case that federal prosecutors first brought forth in June, 2015, three men (out of five total defendants) were sentenced this month for their role in defrauding Medicaid through home care. According to prosecutors, the federal government was bilked for a total of $3.4 million by the defendants, who have now all pleaded guilty to the charges against them.

One female defendant was sentenced in September and received probation while one more defendant will be sentenced in May, 2017. The three who faced sentencing this month included George Epps, 43 from Cleveland, Abdulazis Warsame, 51 from Cleveland, and Amir Ahmed, 51 from Columbus.

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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.