A couple of weeks ago the Oregon Attorney General's Office announced the successful prosecution of three people in the Portland area for pulling off a fraudulent Medicaid claim, which had gone on for more than two years. One wonders why the fraud was not discovered sooner, and the answer is that some people are good at lying.
The AG's Office gave this account: "John Lee Veals of Portland claimed that he was disabled-unable to walk without assistance, drive, brush his teeth or even shave. A Medicaid program designed to allow disabled people to remain at home instead of a nursing facility paid Veals' son, Ramone Lee Veals, approximately $1,600 per month for three years to provide care for his father. John Veals' companion, Christina Underwood, claimed she would provide the care when Ramone was unavailable."
The scheme began to unravel when a state caseworker discovered that Ramone was employed full-time as a construction worker. This triggered an investigation, which found that the disabled man had just been cited for running a red light in Gresham.
His appearance there proved that he could drive and walk, and the three people involved eventually were convicted of first-degree theft. John was sentenced to 13 months in prison, the others to hundreds of hours of community service, and all must pay restitution.
Good for the caseworker who first noticed something wrong. But how can a phony claim like that get started in the first place? And how can it continue for long without somebody noticing that it's a scam?
The answer, according to the Justice Department, is that Veals was in an ATV accident in 2004 and legitimately disabled. But then he recovered while continuing to claim he needed care. When a DHS caseworker checked on him once a year, he was in bed and said nothing, and the others lied that he was still unable to care for himself. It was a case of lying to obtain benefits to which the caregivers were not entitled.
Medicaid is the joint state-federal program to help low-income people with medical needs, and it does not have enough money to help everyone who needs help. It's a shame that some people make things worse with their lies. But to catch them, it might be a good idea to check on them more than once a year. (hh)
"But to catch them, it might be a good idea to check on them more than once a year."
ReplyDeleteSo he is just in bed when they check on him once every 3 months? I'll bet this is rare and that the vast majority of disabled are truly disabled. There is imperfection in every system.
I can see it now...the investigating case worker, played by Jimmy Stewart of course, cunningly stands behind the guy in the wheel chair and drops a book to the floor to see if his head snaps around in surprise...or throws a can of centipedes on the supposedly disabled woman in bed to see if she jumps up and runs off in terror.
ReplyDelete......and a Spencer Tracey for the state-vs- Katharine Hepburn for the defense begins :o)~
ReplyDeleteHonestly though, there is more than should be out there in SSI fraud. It hurts those that need it most.
I know of at least three people that get it, that should not. I am not being flippant about it either. I realize it is needed, and majority of people utilizing it are not abusing it, but we have to hold those that are abusing it accountable.
The reporting and investigation of this unfortunately falls on the AG's office I think.
Granted this is off topic slightly as I am not talking about medicare... To piggy back off MO3:
ReplyDeleteI see ten to twenty a day on SSI that have no business being on it. Most of which have never had a job in their lives. We are talking about fourty year olds who have never held a job.
Thankfully the SSI administration will hold benifits and make people pay back funds, (In some cases) if they are held in jail.
I see Oregon trail cards-a-plenty too... The problem I see, is the dependence on "Govment" that these wide sweeping programs create. We do this by feeling sorry for people and turning a blind eye to the larger problem we create in the process. We just keep adding people, and programs to the list. I literally see generations of people dependant on these programs with no reason, or no goal to get off. Muliply that by 36 Counties in Oregon and you have more than just a rarity.
To further put it into perspective; Add 49 other States into the mix and suddenly the problem becomes even bigger...
I have no problem helping people who are truly in need. I have a problem with helping the other dead beats who are just along for the ride!
Wow, what a scam. You'd think there would need to be more proof.
ReplyDeleteOf course people abuse the Government. But it isn't because it is too big, it is practically starved, it is a skeletal structure.
ReplyDeleteOn the anecdotal, one guy I know with an Oregon Trail card is working very hard at overcoming a mental disability. Many of my friends got laid off, some collect unemployment while searching for work in their fields, but the job market is really tough right now. Another woman received payments while raising her son as a single mother while completing college.
'Each year, U.S. taxpayers subsidize U.S. businesses to the tune of almost $125 billion, the equivalent of all the income tax paid by 60 million individuals and families. These corporations receive a wide range of favors: special corporate tax breaks; direct government subsidies to pay for advertising, research and training costs; and incentives to pursue overseas production and sales. While Congress institutes dramatic cuts in funding for traditional support programs for individuals and families, corporate giants continue to live off the dole.' 2003
ReplyDeletehttp://www.citizen.org/congress/welfare/index.cfm
'The federal government spent $92 billion in direct and indirect subsidies to businesses and private- sector corporate entities — expenditures commonly referred to as "corporate welfare" — in fiscal year 2006. The definition of business subsidies used in this report is broader than that used by the Department of Commerce's Bureau of Economic Analysis, which recently put the costs of direct business subsidies at $57 billion in 2005. For the purposes of this study, "corporate welfare" is defined as any federal spending program that provides payments or unique benefits and advantages to specific companies or industries.'
http://www.cato.org/pub_display.php?pub_id=8230
http://www.thenation.com/doc/20090420/hayes
'In the wake of an earlier round of bank bailouts presided over by George H.W. Bush, I published a short piece in Newsweek entitled “Welfare Bankers” (sadly, the magazine’s digital archives do not extend to October 16-17, 1989). Protesting the moral double standard applied to bankers and to welfare mothers, I argued that the bankers whose institutions were bailed out at a cost of about $156 billion (what a deal compared to today’s bailout!) could perhaps be retrained as child care workers.'
http://economix.blogs.nytimes.com/2009/04/20/welfare-for-bankers/
Hmm, the ghost pictures always start after 5 entries.
ReplyDeleteYep, government or private-sector options, there is some amount of fraud. There is fraud in the insurance industry as well. We pay for it with our increased premiums...just one example.
ReplyDeleteAnd, by the way, unemployment benefits are partly paid by the employer. They have to pay into unemployment insurance, so it's not just a ride on taxpayers' tab.
Sure, when it's approved.
ReplyDeleteAlso, if the employer is honest, but I am completely on a tangent at this point.
ReplyDelete