Medical billing mistakes can be interpreted as a crime by federal investigators hoping to uncover wrongdoing. The U.S. government is highly sensitive about the misuse of taxpayers’ money, sometimes to the point where every billing error seems like potential health care fraud. A fraud investigation can unnerve any Baton Rouge business owner.
Louisiana state troopers claim two Monroe women worked together to cheat AIG insurance. Allegations stem from a business arrangement between the women. Authorities said the defendants billed the insurer for health care services that were never performed.
The son of one defendant required round-the-clock care following an industrial accident. The mother hired the second defendant, head of Cookies Helping Hands of Rayville, to provide sitting services. The business owner then found friends and relatives to do the job.
The accident victim’s mother kept track of the sitters’ schedules and other paperwork and was accused of creating documents for unprovided services. The mother allegedly cashed out or deposited paychecks related to the scheme more than a dozen times in 2010. Insurance claims were filed by the sitting service.
Police said both women reportedly signed bogus notes during 2009 and 2010 stating they had “counseled” Cookies Helping Hands sitters. The mother was charged with 17 counts of insurance fraud; the sitter service owner faces two fraud counts. Other charges may be added.
Cookies Helping Hands was the target of a 2011 Medicaid fraud investigation. The owner was accused of billing the state for over $575,000 for services by sitters who were no longer employed by the company. At the time, the woman was charged with dozens of counts of maintaining and filing false records, although reports did not say whether or how the case was resolved.
The burden is on fraud prosecutors to show a defendant intentionally tried to commit a crime. Criminal defense attorneys make sure defendants aren’t punished simply for making billing errors.
Source: The News-Star, “Owner and customer of area business charged with insurance fraud” Staff Report, May. 09, 2014