Fostering Fraud

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Adult daycare centers or adult foster care homes provide specialized programs and a place to live for developmentally disabled or mentally ill individuals who are no longer able to care for themselves in their own homes. The idea behind the concept is to have residents live in a safe and caring family-like environment while receiving assistance that helps them to live as independently as possible. An article posted on mlive.com tells about two Michigan men who took advantage of residents living in adult care homes in order to bilk Medicare of $1.6 million.

The story states that one of the perpetrators of the Medicare fraud scheme worked as a patient recruiter for a home health care agency. Over a period of two years, he solicited patients from adult day care centers for unnecessary foot-care services in exchange for kickbacks.

The other man involved in the scam was a physical therapist for the same home health care agency. He also recruited patients from an adult daycare center and falsified medical records to make it appear that the beneficiaries qualified for home health services.

The 54-year-old patient recruiter pleaded guilty to conspiracy to commit health care fraud and conspiracy to solicit and receive health care kickbacks. The 30-year-old physical therapist was found guilty of conspiracy to commit health care fraud, three counts of health care fraud and three counts of making false statements relating to health care matters. Both fraudsters are facing up to 10 years in prison.

Because of these two men’s fraudulent actions, Medicare lost $1.6 million and qualified beneficiaries did not receive what they deserved. While they preyed upon disadvantaged adults, they fostered the practice of fraud. (Depending on what the judge has to say, they may soon have the opportunity to be fostered by the penal system.)

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Federal Jury Convicts Michigan Men in $1.6 Million Medicare Fraud Scheme,” written by Gary Ridley and posted on mlive.com on February 26, 2015.

DETROIT, MI — A Flint man and a Detroit-area man have been convicted of federal charges for their roles in a $1.6 million Medicare fraud scheme.

Jurors found 54-year-old Reginald Smith of Flint guilty Wednesday, Feb. 25, of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit and receive health care kickbacks following a trial in Detroit U.S. District Court.

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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.