Turning Point

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a pregnant woman waiting in hospital , sitting in the waiting room and chatting to a doctor with a young nurse in the background.

A turning point is typically described as a time when an important change in a situation occurs, usually one that has beneficial results. Today’s fraud story definitely had a turning point, but there were no benefits reaped by Lopez Scott, 46, of Portsmouth, Va. who committed Medicaid fraud. (However, $188,000 worth of Medicaid benefits were paid back to the government healthcare program.)

As an administrator for Turning Points Residential Care, a nursing facility in Portsmouth that provided residential support services and skilled nursing services to Medicaid recipients, Scott used his position to submit many false and fraudulent claims to the Virginia Medical Assistance Program (VMAP) or Virginia Medicaid. He managed to misrepresent nearly 5,848 hours of skilled nursing services that had been provided to one Medicaid beneficiary. (Those hours  equated to $188,297.39 in health care benefits he was not entitled to.) 

For three years, Scott tried to cover up the fraud by creating fake nursing note entries and even forged a nurse’s signature, even though she no longer worked there. When confronted by the nurse, Scott requested that she lie to investigators after she was no longer employed with the facility.

Here’s the bigger picture. In addition to his position at Turning Points Residential Care, Scott served in the National Guard, worked as a minister, athletic director at two schools and a recreational league basketball coach. (This guy was busy. His community involvement may have helped him as many family members and friends came to support him in court.) 

One good thing – Scott quickly admitted his guilt and paid back the money he stole from his unsuspecting victim and the government. He pleaded guilty to one count of health care fraud. When sentenced, he could get up to 10 years behind bars even though federal sentencing guidelines recommend he receive between 2 and 2 ½ years.

Here’s one other piece of interesting information about this case – the nursing facility is owned by his wife. Scott’s attorney explained that he paid back the $188,000 using money from his wife’s retirement account. (That might make for some very tense date nights to come.)

Today’s Fraud of the Day comes from an article, “Portsmouth nursing facility administrator gets 2 years in prison for cheating Medicaid out of $188,000,” published by The Virginian-Pilot on July 1, 2021.

An administrator for a nursing facility in Portsmouth was sentenced Thursday to two years in federal prison for cheating Virginia’s Medicaid program out of $188,000.

Lopez Scott, 46, of Portsmouth, pleaded guilty in December to one count of health care fraud. The crime carries a maximum of 10 years but federal sentencing guidelines recommended he receive 2 to 2½ years.

 

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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.