Oh Behave

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According to Medicaid.gov, the government benefits program is the single largest payer for mental health services for adults and children in the United States. The owner of an Oklahoma-based behavioral health counseling service and her son, who was employed by the business, took advantage of this fact and submitted approximately $770,000 in bogus claims. (Their false claims were related to Medicaid-eligible children for whom they allegedly provided behavioral health counseling services.)

Over the course of about two-and-a-half years, the mother-son duo devised and carried out three schemes that defrauded Medicaid through their counseling business. The first scheme involved submitting claims for periods of time when the children they were supposedly providing counseling services for were being transported either between home, school or the counseling offices. The second scheme was related to the submission of psychosocial rehabilitation service claims that were greater than the 90-minute time period allowed per child per day. The last scheme involved claims for services that were not actually provided, were provided in groups of two or more children, or were provided for less time than billed.

After being indicted on 151 counts of health care fraud, the mother, 60 and son, 26 ended up pleading guilty to three counts of health care fraud linked to submitting false claims. They agreed to reimburse Medicaid by paying restitution of $769,578.38. They are both facing up to 10 years in prison, three years of unsupervised release and a $250,000 fine for each count.

It’s ironic that these two fraudsters provided behavioral health counseling services. I’m guessing that their sentences could possibly include behavioral counseling. (It will be interesting to see how they handle a dose of their own medicine.)

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”Mother, son plead guilty to defrauding Medicaid out of nearly $770,000” posted on KFOR.com on January 5, 2017.

OKLAHOMA CITY – A mother and a son pleaded guilty to defrauding Medicaid out of nearly $770,000.

Yesterday, officials say Deborah Gray, 60, and her son, Keith Gray, II, 26, both of Oklahoma City, pleaded guilty to three counts of health care fraud in connection with submitting false claims to Medicaid for behavioral health counseling services.

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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.