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A Medicaid Millionaire

Much has been written about how much long term care is costing this country and specifically how much tax payer dollars are spent on government benefit programs, with those numbers continuing to rise.  All true.  But, government waste, ineptitude and an inability to eliminate fraud certainly play a role.  An article in the local newspaper last week caught my eye.  It described the largest settlement of a home healthcare fraud case ever but what was most interesting was the person who was the catalyst for the investigation.

 Richard West, a Medicaid recipient afflicted with muscular dystrophy, who needs nursing assistance and uses a ventilator, learned that certain of his vital services were being cut back because he had “maxed out” his benefits.  Although severely disabled, he still has mental capacity – and determination.  He checked his medical records and discovered that the home health care company that provided him with nursing care was overbilling Medicaid.  He tried reporting what he found to several government hotlines, but got nowhere so he hired an attorney.

 The healthcare company, Maxim Healthcare, has several hundred offices around the country.  The case involved 4 federal agencies and the Medicaid fraud units of at least 3 states.  The investigation reached through almost every state in the country.  For at least 6 years, Maxim billed Medicaid for services it never provided, using what is known as “no show” billing.  Nurses were paid for jobs they never had.  After being nabbed, Maxim agreed to return improper payments it received and pay criminal fines, totaling $150 million.  For his part in bringing the fraud to light, Richard West received $15.4 million.
 West described his frustration in reporting what he found, first to his county social worker, then to the state Medicaid office and then to a Medicaid fraud hotline number and waiting for action.  As anyone who has ever dealt with government bureaucracy knows, you can wait a long time.  West then took matters into his own hands.  Unfortunately, most Medicaid recipients are too sick, physically and mentally, to take on the fight that West did.

 West was literally fighting for his life.  Take away the vital services that Medicaid provides and he feared that he would die.  Now he has too much money to qualify for Medicaid.  Not exactly the “Medicaid Millionaire” who proponents of Medicaid reform claim are collecting benefits that shouldn’t be.  But it just goes to show you that you can’t rely on the government to take care of you.  It took a wheelchair bound 63 year old man on a ventilator to get the government to pay attention to someone stealing hundreds of millions of dollars right from under its nose.