Unfortunately, there seems to be countless ways to defraud our nation’s health insurance programs. In many health care fraud cases, perpetrators are found to have submitted false claims for services they didn’t actually perform. In some of those instances, services were claimed to be provided during times when the claimants were not even in the country. Such is the case with 28 year-old Demagio Smith of St. Louis, Missouri.
As reported by the Eastern District of Missouri branch of the United States Department of Justice earlier this week, Smith has pleaded guilty to conspiracy to make false statements to Medicaid. The report reveals that Smith admitted he submitted numerous false time sheets to Medicaid, claiming he was working as a home health care aide. Part of his duties, he asserted, involved providing care to two female patients inside their homes.
According to the claims, Smith’s duties as a home health care aide were performed between 2013 and 2017. However, during the times listed on his time sheets, Smith was actually either working another job or somewhere on vacation. In fact, Smith was found to have been traveling to such states as California and New Jersey. In addition, he was even on trips to the Virgin Islands and enjoying a Caribbean cruise during the times he said he was working.
Smith is set for sentencing on March 6, 2019.
He was not, however, working alone. As the DoJ report reveals, there were a number of perpetrators who were also found guilty as part of this scheme to defraud Medicaid. Among them was Nova Paden, who pleaded guilty and was sentenced one year ago. “In her plea agreement, Paden admitted to working out of her home as a nursing aide at the same time as she was signing Medicaid time sheets indicating that she was receiving home health care in her residence,” reads the report.
Regina Brown, James Smith, Benita Bell and Tammara Bell were also all previously convicted as part of this same investigation. Each of them pleaded guilty to making false statements to Medicaid or related charges. “Each conspiracy or false statement charge carries a maximum penalty of five years in prison and/or fines up to $250,000,” informs the DoJ, “In determining the actual sentences, a Judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges.”
Richard Quinn is a Special Agent in Charge with the FBI St. Louis Division. In the DoJ report, he offered his view on home health care workers who cheat the system. “Home health care is a more convenient alternative to skilled nursing facilities and it saves tax dollars because it is less expensive,” he is quoted as saying, “People who abuse and cheat the system take money away from those who truly need the services.”
Are you an attorney currently trying a health care fraud case?
Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help you. Our experts have been providing expert clinical services for over 15 years and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Call us at 407-217-5831 or email us at email@example.com.