It’s All About the Details

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Stethoscope on 100 dollar bills symbolizing financial surveillance

Medicaid providers have two reasons for keeping track of the details regarding the care that they give to beneficiaries. Accurate documentation provides relevant and important facts that other care givers need to provide necessary medical services, and it’s the law. (When approved Medicaid providers neglect to keep good records or fudge the records they do keep, CMS doesn’t take kindly to that.)

Keeping copious notes about Medicaid beneficiaries was not Kimberly Rashone Broussard’s thing. The 53-year-old who owned a Las Vegas healthcare company, Phenomenal Angels, LLC, was sentenced for Medicaid fraud for intentional failure to maintain adequate records. She was given a 364-day prison sentence that was suspended and replaced by one year of probation for submitting bills that exceeded the maximum number of service hours in a 24-hour period. (In other words, she was not so phenomenal after all.)

Between January 2017 and June 2018, Broussard was responsible for billing Medicaid for an excessive number of hours under the names of two providers who worked for her company. Investigators found that those two employees were not employed by Phenomenal Angels for most of the time billed, nor did they provide the services described within the claims submitted. (No surprise there. Billing fraud is one of the most common types of abuses within the Medicaid system.) And obviously, Broussard did not maintain the required documentation required by law to back up her claims.

Broussard failed to remember that as a Medicaid provider, she receives taxpayer funds for providing services to Medicaid beneficiaries. With that comes the responsibility of maintaining accurate records and submitting legitimate bills to the government healthcare program. (In addition to serving a year of probation, this fallen angel will also have to pay restitution of $223,248.)

Today’s Fraud of the Day comes from an article, “$200K restitution ordered in Medicaid fraud case,” published by 8newsnow.com on March 2, 2022.

LAS VEGAS (KLAS) — An order to pay $223,248 in restitution and a suspended prison sentence were handed down Tuesday in a Medicaid fraud case involving a Las Vegas company called Phenomenal Angels.

Kimberly Rashone Broussard, 53, of Las Vegas was sentenced for intentional failure to maintain adequate records — a gross misdemeanor — by District Court Judge Jasmin Lilly-Spells. Broussard’s 364-day prison sentence was suspended, and she was placed on probation for one year.

 

 

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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.