Lacking Vision

Confident Doctor shaking hands with patients talk in the hospital

You can be sure that Medicaid examines submitted claims with a proverbial magnifying glass. That’s why it’s important to make sure that every “T” is crossed and every “I” is dotted so that there is no instance of fraud. The office manager of a Las Vegas, Nevada optical clinic, who lacked vision into her responsibilities for submitting Medicaid claims, caused a loss of nearly $60,000 through her Medicaid fraud scheme.

 An investigation into today’s fraud case was initiated after the Medicaid Fraud Control Unit received a tip that the Nevada-based optical clinic had allegedly submitted false claims. The claims submitted by the former optical office manager over nearly five years were for ocular services that were purportedly provided by employees of the clinic. (They were actually not provided at all.)

 When investigators delved into the documentation supporting the claims, they found insufficient information to back up the claims. (No surprise there.) As the office manager and person responsible for submitting the claims to Medicaid, today’s fraudster found herself in clear violation of Medicaid’s rules. (You don’t have to be able to see the bottom line of the eye chart to know that she blatantly submitted false claims.)

The 75-year-old (yes, she was old enough to know better) was sentenced to 364 days in prison, suspended, and placed on probation for three years for failure to maintain proper documentation for services provided to Medicaid recipients. In addition to performing 40 hours of community service, she must also repay $58,630 in restitution to Medicaid.

The Nevada woman’s Medicaid fraud scheme not only stole benefits from the nation’s most vulnerable citizens, but also put herself in jeopardy. I’m sure that a clear message was communicated to her about the possibilities of her being excluded from future Medicaid and Medicare participation. (Let’s hope she has 20/20 vision into how her crime may impact her ability to benefit from government healthcare in the future.)

Today’s “Fraud of the Day” is based on an article, 75-year-old Las Vegas woman sentenced for Medicaid fraud, posted on on August 20, 2019.

Nevada Attorney General Aaron D. Ford has announced that Betty A. Williams, 75, of Las Vegas, has been sentenced in a Medicaid fraud case involving the failure to maintain proper documentation for services provided to Medicaid recipients. The fraud occurred between January 2013 and December 2017.

District Court Judge Valerie Adair sentenced Williams to 364 days in prison, suspended, and placed her on probation for three years. As part of the sentence, Williams was also ordered to pay $58,630.00 in restitution and perform 40 hours of community service. Individuals or businesses convicted of Medicaid fraud may also be administratively excluded from future Medicaid and Medicare participation.

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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.