Miniscule or Massive?

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In July 2017, the Department of Health and Human Services Office of the Inspector General and other state and federal law enforcement partners carried out the largest healthcare fraud takedown in history. Today’s fraudster from Little Rock, Arkansas was amongst those convicted for Medicaid fraud in this nationwide scam.

The woman at the center of today’s “Fraud of the Day” was one of 412 defendants charged across 41 federal districts, including 115 doctors, nurses, pharmacists and other licensed medical professionals. Altogether, the fraud schemes perpetrated by these criminals represented approximately $1.3 billion in false billings. (The massive effort involved the participation of 30 Medicaid Fraud Control Units.)

One of the most common ways to commit Medicaid fraud is to bill for services not rendered. This typically involves a healthcare provider such as a doctor or home healthcare aide who bills the government program for tests or services that were never performed, treatments never provided, or equipment or drugs never delivered. (The cases usually involve falsification of patient records to support their claims.) The Little Rock woman billed $1,438.56 for services she did not provide.

The 39-year-old fraudster pleaded guilty to Medicaid fraud and has already paid the Arkansas Medicaid Program Trust fund the amount she illegally collected. She will also pay another $1,438.56 in fines to the General Fund of the State of Arkansas. Congratulations to the Arkansas Medicaid Fraud Control Unit who worked with the Medicare Strike Force to bring this woman to justice for taking advantage of this important safety net put in place to support vulnerable Arkansans.

Here are some promising statistics: During 2016, the Arkansas Medicaid Fraud Control Unit convicted 60 perpetrators of Medicaid fraud and recovered more than $128 million in the process. Across the nation, $266.8 million was recovered by the Medicare Strike Force just in the second half of FY 2016. (That’s more than double the amount recovered in the first half of 2016.) According to the Coalition Against Insurance Fraud, Medicaid expects to recover approximately $1.9 billion lost to fraud, abuse and neglect in 2016.

Even though the amount of this woman’s fraud seems insignificant in the grand scheme of things, miniscule becomes massive when you add in the amount of damage done by the other 411 defendants. Because the government doesn’t take fraud lightly, other fraudsters contemplating the same scheme will be met with a massive response no matter how miniscule the offense.

Today’s “Fraud of the Day” is based on an article entitled, Little Rock Woman Sentenced for Medicaid Theft,” posted on on November 7, 2017.

LITTLE ROCK, Ark. (News release) – Arkansas Attorney General Leslie Rutledge today announced the conviction of a Little Rock woman for theft. Jene Wyatt pleaded guilty in Pulaski County District Court and has paid $1,438.56 in restitution to the Arkansas Medicaid Program Trust Fund. Wyatt will pay the same amount in fines to the General Fund of the State of Arkansas.    “Jene Wyatt took advantage of an important safety net for vulnerable Arkansans,” said Attorney General Rutledge. “Investigators and attorneys at the Attorney General’s office continue to work diligently to stop this type of fraud.”

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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.