Over six years, Maxim Healthcare Services Inc. had overcharged taxpayers $61 million in fake billings in 40 states. Maxim the home care firm agreed to pay $150 million in penalties.
U.S. agents said it's the largest settlement of its kind. US Justice Department officials patted themselves on the back and claimed it was through their hard work that the settlement was reached?
The real story however is much different. It all started because a paralyzed man was denied care.
Paralyzed by muscular dystrophy, Richard West, 63, of Tuckerton, N.J., must rely on Medicaid care. But he received a notice saying he had exceeded his allowable charges. That seemed improbable under the circumstances, so he dug through his records and found that Medicaid had been billed for hundreds of hours of care by aides who never visited him.
West called federal hot lines to report this rip-off, but got no help. He called again got no help, even after he furnished evidence to authorities wo refused to investigate?
West then retained a lawyer, who began a whistleblower action. Once the action was filed and some attorneys at Department of Justice found out - they came in and took over the case and uncovered a massive fraud.
Under the federal whistleblower law, West got a 10 percent reward of $15 million.
The moral in all this don't trust the government to investigate fraud in Medicaid - they couldn't even recognize it after evidence was provided to them. It was only after West filed a lawsuit and evidence was presented in court that lawyers with the DOJ finally figured out what was going on.
The real story was the break down in the reporting of fraud to Medicaid - which didn't want to investigate the allegations made by Mr. West.
It seems Medicaid couldn't recognize fraud when it was presented to them, or lacked the wherewithal or resources to investigate it.
This aspect of the story of the Maxim fraud was all but ignored by the major media in this case.
It's disgusting that some major corporations cheat Medicare/Medicaid the way they do and then are allowed to settle for a fraction of the amount actually ripped off from Medicare/Medicaid and are then allowed to do business as normal.
In my opinion Maxim should have been disallowed from ever doing business again with Medicaid/Medicare.