What started out as a man frustrated after being told he was over the spending limit of his Medicaid benefits, ended with Federal officials becoming aware to the nation’s largest case of health care fraud! To the tune of $150million big ones!!
Richard West, 63, a man with muscular dystrophy went for some dental work and was told his Medicaid benefits had capped. He needs nursing help and a portable ventilator to get by each day, so this was pretty alarming information. And he didn’t understand how this could be.
“After checking his own medical records, West discovered the company providing him with nursing care appeared to have overbilled Medicaid for hundreds of hours for people who were never there. He called various government hotlines but got no help, he said — so he found his own lawyer.
In a criminal complaint filed as part of the settlement, Maxim Healthcare, a privately held, Maryland-based medical staffing and home health care company, was charged with submitting false and undocumented claims between 2003 and 2009, as well as operating unlicensed health care staffing offices in five states.
In the court papers attorneys for West said Maxim had used no-show billing instead of raises as an incentive for nurses to work for them.
One of West’s nurses, for example, had been told she would be paid $27 an hour. When she received her paycheck, it showed her hourly rate was only $21 an hour. According to the lawsuit, the manager of the office showed her payroll stubs indicating that she was being paid for administering to a patient she had never seen.
“What’s this?” she asked.
“If you want to make the money, this is how we do it,” he responded.
The care health care staffing agencies agreed to a $150 million settlement to resolve matter of defrauding Medicaid and the Department of Veterans Affairs for upwards of a decade.
As part of the Whistle Blowers act West himself will be receiving a $15.4 million share of the settlement for exposing the fraud.
“Both the states and the federal government will share in the money being paid out. In the settlement, Maxim agreed to return $121.5 million in state and federal reimbursement claims, along with another $8.4 million to the Veterans Administration. It will also pay a $20 million federal criminal fine.”
All this because he needed to take care of himself, and no one was listening to him…”No one ever did anything,” West complained. He said it was not hard to figure out what was going on. “The hard part was turning them in.”
Well everyone is all ears now. Good Job Mr. West. Good Job.
- Multistate Settlement Reached In Medicaid Fraud Case (newyork.cbslocal.com)
- Troubled Health-Care Staffing Chain Settles With Government for $150 Million (propublica.org)