A Mission of Omission

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53449333 - doctor's scrub top with stethoscope and one hundred dollar bill

The Social Security Administration (SSA) offers monthly Supplemental Security Income (SSI) payments for children with disabilities. Children that are younger than 18 must have a physical or mental condition that seriously limits their activity to qualify under the agency’s definition of disability. Another requirement is that the child’s income and resources be within eligibility limits. A Virginia daycare provider committed healthcare fraud by lying about her household income in order to fraudulently obtain $245,000 in SSI benefits on behalf of her disabled daughter.

To award eligibility, the SSA considers the income and resources of the child and family members living in the same household. (The agency rules are plain and simple. If the income of both the child and the family members living in the household are more than the amount allowed, the child’s application for SSI payments will be denied.)

 When applying for SSI payments, the mother had to provide detailed information about her daughter’s medical condition and how it affected her ability to perform daily activities. She also had to give permission for the girl’s doctors, teachers, therapists and other professionals who know about her medical condition to provide the agency with information.

 The 13 healthcare aides she provided were actually workers in her home-based daycare center. (The fraudster used Medicaid to pay her employee’s salary even though it was intended to support her child.) By providing false information regarding her daughter’s personal and respite care, Medicaid paid $218,000 to the home health aides who were really her employees, over a span of five years. (That’s a lot of money in addition to the substantial amount of weekly income she received by caring for babies ($160) and other children ($145)).

In addition to lying about her child’s healthcare aides, she also misrepresented her income. (Another no-no.) She failed to report that she had gotten married the same year that her daughter began receiving Medicaid support. This omission allowed her to receive $14,665 in SSI benefits and $14,784 from the Supplemental Nutrition Assistance Program. (If she had been truthful, she would have been ineligible for the SSI payments.)

The 39-year-old Fredericksburg woman pleaded guilty to healthcare fraud and two counts of theft of government funds for executing multiple fraud schemes that caused a loss of approximately $245,000 to the U.S. government. She is currently facing up to 10 years in prison when sentenced this fall.

The SSA takes fraud very seriously. (It’s one thing to be guilty of “omission” by accidentally leaving out some important information on an application, but it’s another thing to be “on a mission” to steal from the government.) Congratulations to the investigators and prosecutors in this case who successfully prevented this woman from ripping off any more government benefit programs.

Source: Today’s “Fraud of the Day” is based on an article entitled, Spotsylvania daycare provider pleads guilty to defrauding government out of $245,000posted on fredericksburg.com on June 19, 2017.

A Spotsylvania County daycare provider pleaded guilty to federal charges Monday involving the use of her disabled child to rip off the government for about $245,000.

Raven M. Zaal, 39, was convicted in U.S. District Court in Richmond to health care fraud and two counts of theft of government funds. She faces up to 10 years in prison when she is sentenced Sept. 22.

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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.