Smoke Screen

36417384 - serious judge about to bang gavel on sounding block in the court room

Criminals are usually pretty good at creating smoke screens. (They strive to cover up their deceptive activities so that their ruse cannot be detected at first glance.) An article published by The Argus Leader tells the story of a former CEO of a community-based counseling service whose guilty plea was rejected by the judge after he discovered a few discrepancies.

The story states that the counselor previously pleaded guilty to one felony count of making false claims and was originally set to be sentenced for filing thousands of dollars in Medicaid claims. But, the judge decided not to proceed with the sentencing, reportedly because the defendant’s original statements in the pre-sentence report did not match the statements given during his plea hearing. (So the judge scheduled a trial instead.)

According to court documents, the counselor allegedly submitted claims to Medicare for services he did not provide. For instance, investigators compared school attendance records with the counselor’s notes and determined that one client was actually in school during the date and time that counseling services were supposedly rendered. (He is also accused of upcoding other claims, meaning that he charged higher prices for more extensive services than he provided.)

It is important to remember that the 41-year-old man is innocent until proven guilty.It will be interesting to see how this case plays out in court, once the smoke clears.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Counselor’s Medicaid Fraud Sentencing Cancelled,” published by The Argus Leader on April 29, 2015.

A man who’d once admitted to Medicaid fraud will take his case to trial after a judge rejected his plea agreement at sentencing.

Shawl Nills, 41, was set to be sentenced Wednesday in Madison for making false claims to Medicaid, but Judge Vince Foley decided not to proceed.

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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.