Between one and two million seniors have been abused by caretakers in the U.S. That doesn’t just include neglect or physical abuse; financial abuse is, in fact, the second most common form of elder mistreatment. And, of course, elder abuse is closely tied to Medicaid fraud. A caregiver who is failing to provide a patient with necessary care is likely to lie about it in billing records, too.
Unfortunately, this is exactly what happened in a recent fraud and abuse case in Missouri. Cheryl Kelly, a 52-year-old woman from Kansas City, was found guilty on two counts of Medicaid fraud and one count of financial exploitation of an elderly person—all felonies. She was sentenced to five years of probation in Sept. 2018. She will also have to pay $15,000 in restitution and a $10,000 penalty.
Kelly’s victim was an elderly veteran. She was hired as his in-home personal care attendant, and she quickly gained his trust and promised to protect his finances. In reality, Kelly was developing an intricate scheme to exploit her patient financially.
According to investigators, she started by manipulating her victim into signing a durable power of attorney. Then, she opened a joint checking account in both of their names, and she had his Social Security and veteran’s benefits deposited into it. Kelly regularly withdrew money from the joint account and used it to pay for her mortgage, her car payment, and her gambling habit.
Kelly managed to gain control of her victim’s finances and avoid suspicion by pretending to be related to him. She falsely told social workers, medical professionals and the Department of Veterans Affairs that she was the man’s daughter or niece—and, somehow, she managed to keep the ruse going long enough to steal thousands of dollars.
This financial abuse is particularly sad because of the victim’s status as a veteran. Veterans are more likely to have physical disabilities and mental health issues, and they’re at a higher risk of loneliness and social isolation—all factors that make them easy targets for abusers.
While she was stealing from the veteran, Kelly was also stealing from the Medicaid program. She was a personal care attendant (“PCA”), not a home health aide or certified nursing assistant. Although PCAs help patients with basic activities like bathing, they are not certified to provide skilled nursing services, and Medicaid has stringent PCA reimbursement standards.
Kelly falsely billed Medicaid for services she didn’t provide, including grooming, dressing and administering medication. At the same that she was caring for the veteran, Kelly pulled a similar stunt with a different patient—another way she profited at the expense of taxpayers.
Ostensibly due to Kelly’s lack of care, the veteran was hospitalized twice while under her supervision. He also received numerous overdraft fees and his rent was unpaid for months, eventually leading to his eviction from his home.
Kelly’s fraud and abuse finally drew the attention of the Missouri Medicaid Fraud Control Unit (MFCU), which led the investigation with the state’s Department of Health and the U.S. Department of Veterans Affairs. Kelly was found guilty at a trial in June 2018.
Despite the egregious nature of Kelly’s financial abuse, it may never have been discovered had the MFCU not noticed the fraudulent Medicaid billing first. If you have any information on Medicaid, Medicare or TRICARE fraud, it’s important that you report it—because it might just be the tip of the iceberg.
Under the False Claims Act, whistleblowers who report insurance fraud may be entitled to a percentage of any verdict or settlement reached. Report fraud today, and you could earn a multimillion-dollar reward.