Compliance Perspective:
Audits must be performed to ensure that nursing home residents’ personal funds and property are protected. Compliance Officers must check that audits are effective. Ineffective audits resulting in theft of resident funds and property may be viewed as systemic failure leading to allegations of false claims based upon substandard quality of care.
The West Virginia Department of Health and Human Resources (DHHR), Medicaid Fraud Control Unit recently announced that a woman from Belington was sentenced after her conviction on multiple felony counts in Randolph County Circuit Court, including Medicaid fraud, financial exploitation and fraudulent schemes
Over a four-year period, this social worker in an Elkins, WV nursing home was able to steal over $50,000 from 13 residents and submit fraudulent Medicaid claims amounting to more than $40,000. Her convictions and sentencing stemmed from an arrest in July 2014, and an indictment for one count of fraudulent schemes, six counts of financial exploitation, and two counts of Medicaid fraud. The total loss to all victims including the Medicaid program was $97,264.59.
Brown was sentenced to serve one year in jail on one count of financial exploitation, and two consecutive terms of 1-to-10 years in prison on one count each of fraudulent schemes and Medicaid fraud. The prison sentences were suspended in favor of seven years of probation, to begin upon Brown’s release from jail. In addition, Brown is ordered to pay full restitution.
(West Virginia Dept. of Health and Human Resources Medicaid Fraud Unit)
