Bon Voyage

55422471 - homecare nurse helping elderly lady to take her daily medicine.

Home healthcare is a great alternative for individuals who want to remain in the comfort of their own homes. Not only does it enable recipients to maintain their independence, but it’s also less expensive than skilled nursing facilities. (In other words, home healthcare saves tax dollars and makes recipients happier.) Today, we take a look at a St. Louis, Missouri in-home care provider who committed Medicaid fraud by claiming to service his clients in their homes while he was off gallivanting around the world.  

Today’s Medicaid fraud abuser got caught for repeatedly falsifying his time sheets, which indicated he was a home health aide providing in-home care for two women in separate residences over four years. What he was really doing was working at another job or travelling outside of the state to California, New Jersey, the Virgin Islands, and taking a cruise to the Caribbean. (It sounds like today’s fraudster had the travel bug and got the U.S. government to pay for multiple vacations.)

The Missouri man, who pleaded guilty to Medicaid fraud, had a female co-conspirator to help him carry out his deceptive scheme. She admitted to working out of her home as a nursing aide, while also signing Medicaid time sheets certifying that she received home healthcare in her residence at the same time. (She was nearly twice his age and should have known better.) She also allegedly filed for Social Security disability payments, then failed to report the income she was receiving from other jobs. (The article doesn’t say, but the Missouri man probably gave her a cut of his Medicaid claim reimbursement while she was also collecting disability benefits she did not deserve.)

It seems that the dynamically deceptive duo was in good company (or bad company depending on how you look at it). Four others were convicted in the same investigation for committing similar crimes involving Medicaid fraud. When sentenced, today’s fraudster will face a maximum penalty of five years behind bars and/or fines up to $250,000.

So, it looks like the former home health aide from St. Louis is about to be booked on an all- expenses paid cruise to federal prison. He’ll have assigned seating at dinner time, he’ll get to share a cabin (uh, prison cell), but unfortunately, he’ll have prison guards instead of a cruise director and will not be allowed to disembark for any shore excursions. (Bon voyage! This guy is on a cruise to nowhere with no return in sight.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Home Healthcare Worker Pleads Guilty to Billing Medicaid While on a Cruise Ship,” released on December 3, 2018.

St. Louis, MO – Demagio Smith, 28, of St. Louis, Missouri, pled guilty to conspiracy to make false statements to Medicaid.  In his plea agreement, Smith admitted that he repeatedly submitted false time sheets to Medicaid that suggested that he was working as a home health care aide during 2013-17, and was taking care of two women inside their homes.  In reality, Smith was actually working at another job or traveling outside of Missouri on the dates and times indicated in his time sheets.  Smith’s out of town trips included travel to California, New Jersey, the Virgin Islands, and a voyage on a Caribbean cruise ship.  Sentencing for Mr. Smith is set for March 6, 2019.   

Smith’s co-defendant in this case, Nova Paden, also pled guilty and was sentenced in December 2017.  In her plea agreement, Paden admitted to working out of her home as a nursing aide at the same time as she was signing Medicaid time sheets indicating that she was receiving home health care in her residence.  

Previous articleGroupthink
Next articleThe Mechanics of Fraud

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.