Disabled NJ Man Richard West Helps Uncover Multimillion Healthcare Fraud

Richard West, a disabled Tuckerton, NJ, resident, got the shock of his life, when he went for dental work and was told his Medicaid benefits had been maxed out. He then checked his own medical records and discovered Maxim Healthcare, the company providing him with nursing care, overbilling Medicaid hundreds of hours, totaling millions of dollars. Of course, he tried to alert the government via various hotlines, but could get nowhere until he got a lawyer.

From such persistence and feistiness a criminal case that ultimately stretched across more than 40 states was born; a case that ended only Monday when one of the nation's largest health care staffing agencies agreed to a $150 million settlement to resolve allegations that it defrauded Medicaid and the Department of Veterans Affairs for nearly a decade.

Federal officials said it was the largest ever settlement for home health care fraud .

It also made West a rich man, earning him a $15.4 million share of the settlement for exposing the fraud that included allegations that Medicaid billing for services provided to hundreds of patients was deliberately and systematically being pumped up to the tune of millions of dollars a year.

In a criminal complaint filed as part of the settlement, Maxim Healthcare, a privately held, Maryland-based medical staffing and home health care company, was charged with submitting false and undocumented claims between 2003 and 2009, as well as operating unlicensed health care staffing offices in five states. Source: Star Ledger

Herein lies a big part of the problem with rising health care costs in this country -- FRAUD and MISMANAGEMENT. Who is guarding the henhouse? You can't send the fox in to do the job. Bravo to Richard West and his sharp wit.

Read the entire article: http://www.nj.com/news/index.ssf/2011/09/tuckerton_mans_resolve_helps_u.html