Worker Bees

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It doesn’t matter how far down the food chain you are in a fraud scheme, if you get caught you’re going to have to face the consequences. A couple in Elizabeth, New Jersey just realized how true this is after admitting to their roles in a coordinated effort to bill Medicaid millions for home health care services that were never done or performed.

According to authorities, the fraud scheme involved two New Jersey home health care agencies, where the principal executives had individuals who had other jobs sign time cards saying they had worked as home health aides. The wife in this scenario did perform services as a home health aide through 2013, but signed off on time sheets under other individuals’ names, receiving cash payments from those individuals. (Guess the allure of ”free” money was more tempting than actually working for it.). She also billed for services that were not rendered at all and convinced patients to sign off on paperwork they knew was false. So, what was the husband’s role in the process? Well, he served as the ”chauffeur,” driving the wife to and from jobs knowing that it was for fraudulent purposes. (Wonder if he received any tips for good service?)

The attorney for the wife acknowledged her guilt, but called her “a worker bee,” while the husband’s attorney called him “the lowest man on the totem pole.” Although both avoided prison time for their low-level participation, they did receive three years probation, with the wife getting an additional four months of home detention. They also have to pay joint restitution of $223,702. (Now that’s a lot of honey…I mean money.)

So, what happened to the queen bee in this hive of fraud? She was recently sentenced to five years in prison for bilking the government out of $7 million.

Source: Today’s ”Fraud of the Day” is based on, ”N.J. couple avoid prison in $7M Medicaid fraud,” an article that ran on NJ.com on February 18, 2016.

An Elizabeth couple, described by authorities as low-level but essential players in a fraud scheme, avoided prison time for their roles in a plan to bill Medicaid millions for home health care services that were never done or performed by unlicensed aides.

Nelson and Sonia Mesa were sentenced to three years probation, with Sonia Mesa receiving four months of home detention Thursday by U.S. District Judge Katherine Hayden. Federal prosecutors had sought prison sentences for both, or at least a minimum of six months of home confinement.

Authorities said the scheme cost Medicaid, the joint state and federal health care program for the poor, their children and the infirm, roughly $7 million

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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.