A Mission of Omission

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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
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.