53449333 - doctor's scrub top with stethoscope and one hundred dollar bill

Defrauding takes teamwork. Today’s fraudster from Bridgeport, Connecticut teamed up with other unscrupulous individuals (and that’s putting it nicely) to steal the Medicaid provider numbers of two licensed healthcare providers. One co-conspirator contributed the personally identifiable information of more than 100 Medicaid clients from the Connecticut Department of Mental Health and Addiction Services (DMHAS). Together, these were the right ingredients for a Medicaid fraud scam where none of the victims knew they were part of a criminal effort to steal nearly $4.5 million from the government healthcare program.

The Connecticut fraudster and one of her co-conspirators operated two businesses in Bridgeport that provided social and psychotherapy services. The two business operators used the companies to bill Medicaid for mental health services that were never provided. Today’s fraudster used the Medicaid provider numbers of two licensed healthcare providers she worked with at DMHAS. (In other words, it was an inside job.) Claims were submitted to the government healthcare program for services that were not provided, nor supervised by the licensed professionals. (They had no idea that their provider numbers were being used to bill for psychotherapy services.)

 Another co-conspirator enters the picture at this point and offers the personally identifiable information of individuals who were Medicaid patients of her employer, a healthcare provider that provided substance abuse treatment including a detoxification program in Bridgeport. (I imagine that these victims had a hard time getting their life back on track due to the addiction problems, but having their Social Security numbers, Medicaid identification numbers and dates of birth stolen had to make matters much worse.) These three ladies (I use that term lightly) used the combined stolen information to bill Medicaid for psychotherapy services allegedly received from the two companies in Bridgeport.

In total, the identities of more than 150 Medicaid clients were stolen. Today’s fraudster admitted that she and her co-conspirators successfully billed about 75 of the patients. When she pleaded guilty to Medicaid fraud, she also admitted that none of the claimed services were provided to the patients as billed. When the 49-year-old is sentenced, she will be facing a maximum of 10 years in prison. She has already agreed to pay restitution of $2,496,618.

One of the co-conspirators in today’s Medicaid fraud case is a repeat offender. She pleaded guilty to healthcare fraud for her role in today’s case, and also for a totally different Medicaid fraud scheme. The other co-conspirator pleaded guilty to healthcare fraud and aggravated identity theft. Both of the fraud team members await sentencing. Thanks to a grand team effort by The Medicaid Fraud Working Group, justice prevailed in this case. (In other words, the best team won, restoring order by working together to protect our nation’s most vulnerable.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, “Bridgeport woman Admits Role in Medicaid Fraud Scheme,” released on December 13, 2018.

John H. Durham, United States Attorney for the District of Connecticut, announced that TOSHIREA JACKSON, 49, of Bridgeport, waived her right to be indicted and pleaded guilty today before U.S. District Judge Victor A. Bolden in Bridgeport to one count of health care fraud.

According to court documents and statements made in court, beginning in January 2012, Jackson and Juliet Jacob operated two businesses, Transitional Development And Training (TDAT), and It Takes A Promise (ITAP), both located at 360 Fairfield Avenue in Bridgeport, which provided social and psychotherapy services.  The investigation revealed that Jackson and Jacob used ITAP and TDAT to bill Medicaid for psychotherapy services that were never provided.  As part of their scheme, Jackson and Jacob used the Medicaid provider numbers of two licensed health care providers who had neither rendered nor supervised any of the psychotherapy services that Jackson and Jacob billed to Medicaid.  Jackson, and the two licensed providers, were employees of the Connecticut Department of Mental Health and Addiction Services (DMHAS).  The two providers did not authorize Jackson or Jacob to obtain provider numbers for them at TDAT or ITAP, and were not aware that TDAT or ITAP were billing Medicaid as if the providers had personally rendered the psychotherapy 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.