Richard West, a New Jersey resident and Vietnam veteran suffering from muscular dystrophy, relies on Medicaid benefits to pay his medical bills.
During a visit to his dentist he was told that his benefits has maxed out. Shortly after he said his services were being cut back and he wasn’t receiving the care he needed due to the max in benefits.
West sat down with his medical records and singlehandedly uncovered one of the largest health care fraud cases in the country. Apparently his records showed that his medical provider had been over billing Medicaid for hundreds of hours of service and doctors that West never saw or received.
Once he noticed the glitch in his billing he actively started trying to turn the company in. This was not the easy part, he mentioned. He originally attempted to turn them in to a country social worker, then the New Jersey Medicaid waiver office, and the Medicaid hotline for fraud. He found it hard to find someone to help until he brought on his own lawyer.
The case started to gain speed and a criminal complaint was filed against Maxim Healthcare. They were “charged with submitting false and undocumented claims between 2003 and 2009, as well as operating unlicensed health care staffing offices in five states” – Source.
On September 12, 2011 the case ended with a settlement of $150 million — $15.4 million that will go to Richard West alone.
“In the settlement, Maxim agreed to return $121.5 million in state and federal reimbursement claims, along with another $8.4 million to the Veterans Administration. It will also pay a $20 million federal criminal fine” – Source.
Officials have reported that Maxim operated under an incentive compensation structure which meant the more you billed the more revenue you would see. Nine people, including three senior managers, have pleaded to felony charges. However, no top executives of the company have been charged.
Maxim CEO Brad Bennett states, “We take full responsibility for these events set forth in the deferred prosecution agreement and we are pleased to reach a settlement that will allow us to move forward with the important work of caring for our patients and clients who depend on us each and every day” – Source.
As a lesson, one should always, always, always check their medical records to make sure billing is correct.
If you have been scammed and would like to file a scam report, please click here.