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.  

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Larry Benson
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.