Too Pushy

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Not many people like to be pushed into something they don’t want to do. The owners of three Chicago-area home health care companies pushed their employees to sign up unqualified Medicare beneficiaries for home health care services and the government pushed back hard in their defense.

Today’s fraud article is related to a Medicare Fraud Strike Force crackdown involving 243 individuals and $712 million in fraudulent claims submitted to Medicare for home health care services that were not needed. Most recently, two defendants including two registered nurses (RN), confessed to their part of the scheme that cost the government $45 million. (Definitely not chump change.)

The two RN’s entered plea bargains that were similar in nature. They both claimed that they were directed by the company owners and supervisors to falsify patient paperwork to make them appear sicker than they really were. (The more ill the patient, the greater the amount of money received from Medicare.)

The nurses were aware that their patients were insured by Medicare and were not qualified for homebound services, but despite that fact, they continued to certify non-homebound beneficiaries for home health care more than 150 times. (This cost Medicare between $400,000 and $500,000.)

The scam involved giving many of the patients the same diagnosis. For example, the nurses were instructed by supervisors to mark all women as incontinent because women have babies. Despite the fact that most of the patients served by the three home health care companies were able to leave their home without assistance, they were also instructed to mark these patients as homebound. (Did they never think to say ”no” I will not falsify the patient information? That would have been too easy.)

The two nurses pleaded guilty to one count to commit health care fraud. They both face a maximum sentence of 10 years in prison. To date, four other nurses and the president of recruitment for a company that referred patients to the agencies have all pleaded guilty. The three owners who are alleged to be the ringleaders of the scheme are scheduled to be tried.

There are probably more convictions to come regarding this case. (In total, 15 people are alleged to be involved with these three companies and the Medicare scam.) It’s a certainty that the government doesn’t like bullies, and any others convicted in the scam will be punished appropriately.

Source: Today’s ”Fraud of the Day” is based on an article entitled, ”More Nurses Plead Guilty in $45M Medicare Fraud Scheme,” posted on law360.com on December 16, 2016.

Springfield (December 16, 2016, 4:21 PM EST) — Two more nurses and an office manager pled guilty in Illinois federal court on Thursday to one count to commit health care fraud in litigation involving several Chicago-area home health care companies in a $45 million Medicare scheme.

Registered nurses Mary Mendoza and Ronald Malalis, along with office manager Janet Guerrero entered plea bargains in the alleged scheme run by the owners of Lincolnwood-based Pathways Home Health Services LLC, Donnarich Home Health Care Inc. and Josdan Home Health Care Inc. The owners of the three home health companies, Josephine, Richard and Maribel Tinimbang, are the alleged ringleaders, with help from staff.

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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.