Home Alone

19253081 - close-up of file folders on the shelves at office

Unless you have a clone, it is pretty hard to be in two places at once. However, an article in the St. Louis Post-Dispatch reports that a man was able to defraud an Illinois health care program by submitting false bills while serving time in prison. (That’s an interesting way to multi-task – using duplicity to deceive the government and your victims.)

The story states that the prison inmate claimed to be taking care of a patient at the time he was actually serving time in jail. He submitted fraudulent claims to the Illinois Medicaid agency, which runs a program designed to help keep beneficiaries out of nursing facilities by providing assistance with general household duties and personal care at home. (The program not only saves the state money by reducing costly health care fees, but also allows the patients to be more comfortable in their own residences.)

This fraudster is not the only one to capitalize on the home care program’s vulnerabilities. Further research revealed that a total of 43 people claiming to provide personal assistant services have been charged with fraud against the state program. (This guy was caught in the third wave of the investigation.) He faces up to 10 years in prison, a $250,000 fine and up to three years of supervised release.

This criminal, along with the other 42 defendants charged with fraud, stole money from a government program designed to help vulnerable Medicaid beneficiaries. By representing themselves as personal assistants and caregivers, they all deceived their customers and also harmed the reputations of those personal assistants who actually perform their duties correctly. (It looks like this fraudster’s days of leaving his patients home alone are over.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Man Commits Medicaid Fraud from Illinois Jail, Court Says,” written by Blythe Bernhard and published by the St. Louis Post-Dispatch on September 5, 2014.

A man submitted claims for working in an Illinois health care program while he was incarcerated in an Illinois jail, federal prosecutors announced today.

U.S. Attorney Stephen Wigginton of the Southern District of Illinois said Christopher Spivey, 30, pleaded guilty to submitting bills to the state Medicaid agency for caring for a patient in a program aimed at keeping people in their own homes instead of nursing facilities. Spivey was incarcerated at the Richland County Jail in Olney, Ill. at the time he claimed to be taking care of the patient. A sentencing date was not announced.

Read More

Previous articleUsed Fraud Salesman
Next articleBetrayed by Trust

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.