It’s the Little Things

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Cropped shot of a medical professional filling out paperwork

The U.S. Government is good at tracking down trivial details, but most fraudsters think that it is a bumbling bureaucracy that is inefficient and unaware of many of the little lies criminals submit to illegally qualify for healthcare benefits. Sikirat Adunni Brown, 60, of Upper Marlboro, Md., found that she was very wrong about that assumption.

Brown was quite the busy bee between January 2014 and June 2020, working as a personal care aide for at least eight different home health agencies in the District of Columbia. Brown was hired to help Medicaid beneficiaries perform activities of daily living including getting in and out of bed, bathing, dressing, and eating. (This is a very important service for vulnerable Medicaid beneficiaries who need this type of help to safely make it through the day.)

Brown fudged her timesheets a bit. She was required by her employers and Medicaid to document the type of care she provided to her clients, then submit those timesheets to the home health agencies, which in turn would bill Medicaid for the services that she supposedly rendered. Except, she falsified her timesheets and, in some instances, claimed she provided more than 20 hours of personal aid services in a day. Brown also claimed to provide services when she was traveling outside the D.C. metropolitan area. (That is highly unlikely, unless she cloned herself.)

Those little details that Brown thought would get past the Medicaid auditors didn’t. When she pleaded guilty, Brown confessed to causing the D.C. Medicaid Program to issue $343,539 in payments for services that she never provided. She also claimed she provided services to one beneficiary during the COVID-19 pandemic, but the beneficiary said she did not. (It’s always important to check the accuracy of insurance statements provided by your health insurance provider. You never know when a provider might try to pull the wool over your eyes.) And as if that was not bad enough, Brown paid kickbacks to one beneficiary to back up her claims.

Brown pleaded guilty to healthcare fraud in July for falsely claiming that she provided services during the COVID-19 pandemic. The judge sentenced her to 13 months in prison for defrauding the D.C. Medicaid program. She was ordered to pay $343,539 in restitution and $201,645 in a forfeiture money judgment.

Brown is not the only person to commit billing fraud recently. She is the tenth former personal care aide in the last three years to plead guilty to defrauding the Medicaid program in the District of Columbia. Five of those aides received a sentence of 13 months in prison, while a sixth got 15 months behind bars.

My guess is that Brown will not be the last fraudster to be charged with healthcare fraud related to the pandemic. If you have any tips regarding individuals committing health care fraud, please call the Department of Health and Human Services’ Office of Inspector General hotline at (800) HHS‑TIPS [(800) 447-8477] or the D.C. Office of the Inspector General at (800) 724-TIPS [(800) 274-8477].

Today’s Fraud of the Day comes from a Department of Justice press release, “Maryland Woman Sentenced to Prison for Defrauding Medicaid Out of Hundreds of Thousands of Dollars,” dated November 8, 2021.

WASHINGTON – Sikirat Adunni Brown, 60, of Upper Marlboro, Md., was sentenced today to 13 months in prison for defrauding the D.C. Medicaid program out of more than $340,000.

The announcement was made by U.S. Attorney Matthew M. Graves, Wayne A. Jacobs, Special Agent in Charge of the FBI Washington Field Office Criminal Division, Maureen R. Dixon, Special Agent in Charge of the U.S. Department of Health and Human Services’ Office of Inspector General for the region that includes Washington, D.C, and Daniel W. Lucas, Inspector General for the District of Columbia.

 

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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.