Practical Nurse, Impractical Fraud

By   /   February 12, 2016  /   Comments Off on Practical Nurse, Impractical Fraud

A recent pair of reports by the Rochester Democrat & Chronicle detail a licensed practical nurse in upstate New York who exploited a special needs patient to cheat the state Medicaid program of nearly ten thousand dollars’ worth of payments for services she did not provide.

According to the reports, the New York State Attorney General’s Medicaid Fraud Control Unit peeled back the layers on the Medicaid fraud, after it pored through documentation kept by the Medicaid Fraud Inspector General. A subsequent review of financial and cell phone records, along with a series of interviews, brought forth allegations that the private-duty nurse intentionally stole from the state’s Medicaid program when she charged it for 42 extra hours of care – totaling $8,838.00 in false billings – over four months. (So this supposed caregiver pursued a passion-profession, and then proceeded to financially drain the programs that supported her job? Alas, I digress.)

Six months later, the nurse was formally charged with nine felonies that together carry a maximum penalty of up to seven years in the state penitentiary. All but one of the charges were for multiple counts of defrauding New York’s Medicaid program, by knowingly offering a written instrument containing false information in the first-degree. The other was for third-degree grand larceny, as the alleged extent of her theft far exceeded $3,000.00.

The nurse ended up pleading down to a misdemeanor charge of Petit Larceny, more commonly known as “petty theft.” (Call me preachy, but “petty” doesn’t quite cover the ethical transgressions I associate with this type of “caregiving.”)She was further sentenced to three years’ probation and ordered to repay the stolen $8,838.00. (We hope the state tacked on an interest rate on par with that of Medicaid penalties.)

A compromised physical or mental capacity is what makes people become patients, and a caregiver’s effectiveness hinges on established trust with whom they’re tending. Duping the government certainly is risky and illegal, but capitalizing on a patient’s disadvantaged state to collect funds intentionally allocated for their needs is beyond the pale.

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