Peace of Mind


It is estimated that 65.7 million informal and family caregivers provide care to someone who is ill, disabled or aged in the United States. These Americans have to balance the demands of work, home, kids and caring for a loved one who needs assistance. (To say that caregiving can be overwhelming is an understatement.) Home healthcare can be a great choice – one that is affordable and gives peace of mind to those who provide care and for individuals who want to be cared for in their own home. However, a Winterville, North Carolina woman disturbed the peace of mind of many when she committed Medicaid fraud by submitting nearly $50,000 in fraudulent claims through her home healthcare company.

The North Carolinian, who happened to be a registered nurse, owned a Greenville business that provided in-home personal care services for Medicaid recipients. Her employees helped the company’s clients with daily living tasks such as cooking, cleaning, bathing and hygiene.

Over two-and-a-half years, the business owner directed her personnel to falsify time sheets and care notes so that she could submit fraudulent billing claims to Medicaid for services that were not provided. (She generated even more revenue by paying her Medicaid clientele kickbacks to refer new customers her way. That is obviously illegal.)

 The home healthcare company owner pleaded guilty to two felony counts involving Medicaid fraud and the illegal kickbacks. She was sentenced to five years of supervised probation in Pitt County Court. If she violates her probation, she’ll be subject to 12 to 17 months in prison. (That’s definitely a huge incentive to obey the court order.) The fraudster must also pay back $49,438.48 of the taxpayers’ dollars to the North Carolina Medicaid fund.

Home healthcare has long been recognized for being vulnerable to fraud, waste and abuse. Billing Medicaid for services not provided not only wastes taxpayer money and drives up healthcare for all taxpayers, but also robs those who truly deserve the benefits of peace of mind and the care that they need.

 Fortunately, the government is getting pretty good about catching criminals who commit Medicaid fraud. In North Carolina alone, the Medicaid Fraud Control Unit conducted nearly 400 investigations and recovered $80,416,129 in improperly awarded funds. (That’s a great statistic that can restore peace of mind to all American taxpayers.)

 Today’s “Fraud of the Day” is based on an article entitled, “Winterville woman convicted on health care fraud,” published by Daily Reflector on October 31, 2017.

A Winterville woman pleaded guilty Monday to two felonies involving Medicaid fraud and illegal kickbacks, North Carolina Attorney General Josh Stein announced in a Monday news release.

Rosa Powell, age and address not provided, was sentenced to 60 months of supervised probation in Pitt County Court, the release said. She faces 12 to 17 months in prison if she violates her probation, the release said. She also will restore $49,438.48 to taxpayers via the state’s Medicaid fund.

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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.