Free Housekeeping

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Housekeeping is not usually anyone’s favorite activity, especially if you are elderly and can’t move well enough to take care of your home like you once could. Perhaps that’s one of the reasons why today’s deceptive couple enticed patients to participate in their Medicare fraud scheme by providing what some termed as “free housekeeping.” A husband and wife, who ran a Dallas-based home healthcare company, committed Medicare fraud by drumming up business using stolen patient names from hospitals where they formerly worked and billing for services that did not occur.

Home health companies usually provide care for older and disabled patients after they are discharged from hospitals. Physicians, nurses, therapists and home health aides visit the patients in their homes, providing medically necessary services and helping around the house so they can recuperate comfortably in their own home. Each time a visit is made, Medicare gets billed. (This company worked the same way, except many of the visits made were not medically necessary or performed.)

The husband, who used to work at a Dallas-area hospital as a patient registration specialist, accessed and stole the computerized records of more than 3,000 patients. (After the hospital learned of his crime, he was fired, but not before using the stolen patient information to solicit new clients.) His wife, who was a registered nurse at another area hospital, also stole patient information that would help their home health company grow. (She was also fired.) Employees were instructed to cold-call senior citizens from the stolen lists to sell them services they didn’t qualify for or need. The woman also falsified notes and patient diagnoses to keep the company’s patients as clients.

Their home healthcare company provided services that were intended for homebound patients. (However, they weren’t very homebound. Many that used the company’s services were observed mowing their lawns and driving.) An investigation into the matter was opened when a company employee alerted one of the hospital’s police force that the husband and co-owner of the company brought her patient lists to solicit new clients. A company search was ordered and evidence seized included 200 names from one hospital and 1,000 from the other one. At that point, the case was turned over to the Department of Health and Human Services’ Inspector General.

Federal agents delved deeper into the case and discovered that several company employees were instructed by the husband to call the names listed on the stolen patient lists. The man admitted he used his employees to make the calls because he had a heavy, foreign accent. (He even hired a bilingual speaker to call Spanish-speaking patients to convince them of their need for social services.)

Some of the patients testified that legitimate services were provided; however, others weren’t seen at all, or had visits from staff where no care was provided. Others just wanted the home health aides to clean their houses. (They were enticed by grocery gift cards and cash.)

The 52-year-old husband and his wife from Dallas were sentenced to 30 months in federal prison for their Medicare fraud scheme. The wife will also have her nursing license revoked. They are both responsible for paying nearly $278,000 in restitution to Medicare.

When sentenced, the judge told the man that he should have known better. Despite the defense attorney’s attempt to paint the woman as a subservient wife, the judge noted that she was a quiet, but very smart woman who was a leader in the scheme. (The judge also told the couple that they had violated the “Holy Grail of what you can’t do as a healthcare professional.” Definitely not something to be proud of.) Where this couple is headed, there won’t be any free housekeeping available, but at least they’ll have a small cell that won’t take too much time to tidy up.

Today’s “Fraud of the Day” is based on an article entitled, Couple who stole Parkland, Baylor patient names to bill Medicare get federal prison timepublished by The Dallas Morning News on July 31, 2017.

A Dallas company enticed patients to use Medicare-funded home health care they didn’t need by giving them grocery gift cards and cash, federal prosecutors say. 

Dallas Home Health Care owner Viju Mathew and his wife, Mariamma Viju, were sentenced Monday to 30 months in federal prison for their scheme, which even pitched the health services as a way to sign up for free housekeeping.

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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.