Massachusetts Fraud Siphons $10 Million from Medicaid Program


This one comes from Massachusetts, where the weather is cool and crisp and the Medicaid payouts are as enticing as the salty sea air. According to The Boston Globe, 10 individuals—many of them doctors—were indicted this month for allegedly pilfering millions from taxpayer pockets.

In perhaps the largest case, Adlife Healthcare was charged with allegedly overbilling Medicaid more than $5.5 million. Defense lawyers argued that the prosecution was exploiting small accounting and paperwork issues, and that though she was billing for dead people, that shouldn’t be a surprise: ”Is it supposed to be a shock that some of her clients pass away?”

Of course, the government itself doesn’t have a very good record when it comes to paying dead people, but at least the government doesn’t profit off it. There is some hope: last year, prosecutions in Massachusetts recovered more than $66 million.

So the question of the day is…wouldn’t it be better for the state to be more vigilant and invest in improved technology so that the state’s $10.4 billion MassHealth budget goes to those in need, rather than those exploiting the needy?

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Medicaid Provider Accused of Fraud,” by Patricia Wen and Brian Ballou, published by The Boston Globe, Oct. 1, 2011.

Framingham – A nonprofit agency that promoted itself as a compassionate organization devoted to helping disabled, indigent adults stay in their homes was accused by state prosecutors yesterday of running a cynical scam, billing the state for about 20 patients who had been dead for some time.

Prosecutors also said Adlife Healthcare – run by Sharon Richardson at locations in Framingham, Dorchester, Hyannis, and West Springfield – charged Medicaid for home health aid services rendered to more than 100 infirm patients even though its staff had not done the work.

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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.