Healthcare Fraud Boom

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A young girl and her mother are in a doctor's office. The daughter is holding a stuffed teddy bear. They are happily talking to their doctor.

It’s no secret that healthcare costs are skyrocketing. Instead of turning to assisted living facilities or nursing homes, many individuals are now relying on home healthcare services to keep costs lower. The U.S. National Library of Medicine reports that as of this year, individuals over the age of 65 years will outnumber those under the age of five. This statistic is foreboding because while government healthcare programs are onboard with helping Americans to age with dignity at home, you and I both know that this is a perfect opportunity for a healthcare fraud boom. (Criminals rarely turn down a chance to steal benefits they don’t deserve.)

Today’s fraudster is a Nottingham, Maryland home healthcare provider who was hoping to take a free ride on the government by claiming he was providing home healthcare services when he was actually taking trips. While working for an area home healthcare company, he submitted claims stating that he was caring for two wheelchair-bound Medicaid beneficiaries who had HIV. What he really did was stick the government with a bill for several trips to Atlanta, Boston and Puerto Rico. (Wouldn’t it be wonderful to receive a free vacation from the government each year? Apparently, this fraudster thought this was one of the benefits he should receive.)

Instead of providing in-home personal care services to his assigned patients, he was most likely sightseeing, eating out at restaurants, dressing himself in a swimsuit and applying sun tan lotion several times a day. (This was a totally different idea of home-based personal care services.) Over nearly four years, the home healthcare provider falsely claimed more than 150 times that he was taking care of his patients.

The 41-year-old man was convicted of felony Medicaid fraud for lying to the government healthcare program. He received a sentence of five years in prison, suspended and three years of probation. He also has to pay back $32,000 in restitution to Medicaid. (He’s not allowed to leave the state of Maryland without prior authorization. That will definitely put a cramp in his vacation plans.)

Today’s “Fraud of the Day” is based on an article, “Nottingham Man Convicted of Medicaid Fraud After Pretending to Care for Patients When He Was Actually On Vacations,” posted on Baltimore.CBSLocal.com on August 26, 2019.

BALTIMORE (WJZ) — A 41-year-old man was convicted of felony Medicaid fraud related to the care of two wheelchair-bound Medicaid beneficiaries living with HIV.

Mark Wilkerson was sentenced to five years in prison, all suspended, with three years probation, and ordered him to pay more than $32,000 in restitution to the Medicaid program.

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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.