Vet with Muscular Dystrophy Beat Medicaid Fraud from Wheelchair

posted on Sep 21 by Amanda in the Advocacy, Disability Law, Disability News, Healthcare, Muscular Dystrophy, Veterans category

The fight against Medicaid fraud reached a milestone when a feisty Vietnam veteran named Richard West, who has muscular dystrophy, blew the whistle from his wheelchair and ultimately was awarded $15 million dollars for his persistence. The charges were levied against Maxim Healthcare for defrauding the government by making false and undocumented Medicaid claims. Maxim is a large, privately held, Maryland-based medical staffing company with over 300 offices in 40 states, and they were ordered to pay over $150 million in damages, fines, and reimbursement to the government and individuals they scammed like West.

West first encountered the scam when Medicaid told him that he had maxed out his benefits in 2004. The 63-year-old New Jersey vet looked into his bills and found that a medical agency that provides home health aides was billing Medicaid for services he never received, including nurse visits and mobility equipment. In his efforts to uncover the scam, West first tried to get government officials to investigate Maxim Healthcare. When that failed, he took matters into his own hands by filing a lawsuit. As a result of his lawsuit, the government uncovered that Maxim had been submitting false, undocumented claims between 2003 and 2009 totaling more than $60 million in fraudulent Medicaid reimbursements, as well as operating unlicensed healthcare staffing offices in five states.

In a landmark decision, Maxim was ordered to pay over $120 in penalties and reimbursements for the fraudulent claims made to Medicaid, as well as over $8 million in damages to the Veterans Administration. The company also had to pay around $20 million in fines to the federal government for defrauding them. Because of his efforts to take Maxim to court and hold them accountable for their actions, Richard West received a portion of the settlement.

The tenacious veteran is an example of why beneficiaries of Medicaid and Social Security benefits need to stay vigilant with their own healthcare bills to help fight against the billions of dollars in fraud that goes unreported each year. West was quoted on his website as saying, “From my wheelchair, on a ventilator and oxygen, I have spent the last seven years in this fight. Sometimes the good guy wins. Anyone who suspects fraud needs to speak up; it’s the right thing to do.”

As part of the settlement, West received $15.4 million in damages because of the fraudulent claims. When asked what West was going to spend his money on, he replied that he will get a new wheelchair accessible van, make improvements on his home, as well as donate to charities that help individuals with disabilities and conditions like muscular dystrophy.

The winnings are a bit of a mixed blessing, however, as noted by West’s attorney. “He no longer qualifies for Medicaid,” she stated with a smile.

Sources:

http://www.foxnews.com/us/2011/09/14/wheelchair-bound-vietnam-vet-uncovers-multimillion-dollar-medical-aid-fraud/

http://www.courierpress.com/news/2011/sep/15/maryland-co-pay-150-million-health-fraud-probe/

http://www.nypost.com/p/news/local/whi_tleblower_OtagWuaoKWNaDdMJLqA2vJ

http://www.nj.com/news/index.ssf/2011/09/tuckerton_mans_resolve_helps_u.html