Mark Mandell, Esq.
Imagine a single
mom with five kids with no income on record and struggling to make ends meet –
sounds like an eligible candidate for government subsidy programs. She signs up
for the SNAP (Supplemental Nutrition Assistance Program) and Medicaid for herself and her children and gets
government assistance to help cover her rent.
But in reality,
she’s married, her husband has an all-cash business, which allows her to rake
in thousands of dollars a month via welfare programs and remain undetected by
the government.
This situation is
all too common throughout the US .
Savvy individuals are able to game the healthcare system through tricks such as
getting married under religious law but not state law. These individuals scam
taxpayers time and time again.
The amount of
taxpayer money down the drain from fraud and spent on curbing fraud are
jaw-dropping.
The federal
government is projected to lose $19.6 billion in “improper payments” under the
Medicaid program. Accurate fraud figures can be hard to calculate since
improper payments aren’t necessarily fraudulent--they could be due to an error
either by the government or recipient. Fraud estimates for fiscal year 2014 are
up from last year’s $17.4 billion, but down from 2010’s $22.5 billion
estimation of improper payments.
Federal Medicaid
Spending is projected to be $298 billion in 2014, and Medicare is projected to
be $603 billion. The SNAP program cost $79.9 billion in 2013. The White House
requested $389 million to fund the Department of Health and Human Services’ Office of the Inspector General
in an attempt to better curb waste in the 2104 budget.
In February of this
year, the D.C. U.S. attorney’s office announced the largest health-care fraud
takedown in the history of the District. The multi-year effort led to more than
20 arrests and schemes involving millions of dollars in fraud,
kickbacks and false billings in the home health-care services
field throughout the nation’s capital.
Ron Machen was the U.S. attorney for Washington , D.C.
on the case. He said his office was tipped off to the scheme when certain
agencies were requesting 300% more than other Medicaid beneficiaries over the
past several years.
“We were wondering
what the reason was for such a skyrocket in growth,” Machen says in a recent
Fox News report. “We used wires, cover agents and beneficiaries to uncover
them.”
What they uncovered
was eye opening. The investigation busted personal care assistants
misrepresenting the amount of time they spent with beneficiaries. These
beneficiaries would fill out inaccurate time sheets and submit them to home
care agencies. While the sheets listed them as being seen by assistants for up
to eight hours, in reality the personal care assistants never saw the patients.
The beneficiaries
were elderly, disabled and low-income, said Machen, and recruiters would offer
them kickbacks of $200 a week and coach the patients on what to say if someone
asked about their work.
Healthcare fraud is
also an increasing concern with the Obamacare overhaul.
If you have questions about health care
fraud, or are afraid that you may have been the victim of a fraud, contact the
experienced attorneys at Fausone Bohn, LLP, by calling (248) 380-0000 or online
at www.MichiganFraudLawyer.com.
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