Healthcare Compliance Perspective:
Sometimes a fraud comes along that is just plain ghastly. What can we take away from it? Perhaps a perpetual reminder that our industry is entrusted with the lives, well-being and safety of human beings, so often unable to care for themselves, and otherwise no different than you and me.
Georgia state authorities announced last week that their collaborative efforts have led to the dismantling of a systematic elder abuse and Medicaid fraud scheme coordinated by three individuals-an unlicensed personal care home owner, an illegal social security payee and a nurse practitioner. On December 13, 2017, the three were charged in a 17-count indictment for violations of the Racketeer Influenced and Corrupt Organizations (RICO) Act; Neglect to a Disabled Adult, Elder Person, or Resident; Exploitation and Intimidation of Disabled Adult, Elder Person, or Resident; and Operating an Unlicensed Personal Care Home.
The woman was arrest for operating an unlicensed personal care home in September 2017, after some of the residents living in nearby apartments the woman rented were begging for food and concerned residents reported this to the authorities. An investigation resulted in seven elderly and/or disabled adults being removed from the apartments and relocated to licensed facilities. Further investigation uncovered three other elderly and/or disabled persons in another apartment location that the woman was operating. These victims were also relocated.
The scheme involved a man who would act as the residents’ Social Security payee and then funnel the money belonging to the residents to the woman acting as their personal care provider after keeping a portion for himself. The third part of the scheme involved a nurse practitioner who would inject psychotropic medications and give various other prescriptions to the residents. She would also provide the personal care provider and the man involved with the medical forms needed to sign the residents up for government benefits which the pair would then keep for themselves.
