re: Data scientist uncovers massive scale of “personal care” Medicaid fraud in Maine (thread)

Man, seeing those numbers laid out like that is insane. That single-code billing trend is such a massive red flag.

I was actually reading up on how the government handles this stuff because it seemed too easy for these shell companies to just take the money and run. It turns out the DOJ uses data mining exactly like this to target these phantom agencies.

From what defense teams like Oberheiden P.C. say about how these crackdowns work, once the feds spot those inflated claims, they usually freeze assets and bring in the MFCU almost immediately.

I really hope this data scientist forwarded their findings straight to the state auditor or the DOJ. These fake agencies need to be shut down yesterday.

Tboy was on here yesterday spouting off about Dems being the party of freedom. You won’t find him here. He supports this stuff

It is unclear from the portion of the article posted as to how they are doing their billing. If they are 5X the state average are they 1) actually charging five times the rate or 2) are they billing for multiple 15 minute intervals. Either way, it looks very fraudelent. My guess is that they are overbilling, if they are actually even going into the home, documenting 1.25 hours worth of work for a 15 minute trip. Medicaid, much like Medicare, will only pay for the code, so they can bill 5X the price of others for the same code, but will only get what Medicaid pays (ie, $223), however if they bill for 5 fifteen minute sessions they would be getting $1115). One easy way to prove it would be to audit the charts, which is mandatory documentation, and then account for the time of each employee. If you are paying an employee for 8 hours of work and they make 8 one hour fifteen minute visits, you know there is fraud. These people are smart and greedy, and they know how to manipulate the system. They also know all they have to do is be smarter than the auditor, which in some cases is not too hard, especially when they are too lazy to look.

Where can one access these records? I think someone I know is running a home healthcare scam.

1. Decent Health Care. The name alone should tell you something’s up. “Yeah- I want decent healthcare. Don’t give me good healthcare. Decent will do.”

2. Maine? Until recently I thought Maine was a low population low drama kind of state. I wouldn’t have thought there was a large enough population to make Medicaid fraud feasible. At least not for long before someone caught on pretty quickly.

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NOTHING is more absolutely disgraceful as a Democrat politician

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I really believe the modern Democrat Party is a criminal cartel

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Wait a minute, these guys are stealing 10s of millions of dollars.......and you are gonna fine them for "fixing" wages.

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My point is that they are fraudsters all the way around. They are fraudulently billing to increase revenue while colluding to reduce costs.