Mention the words "Medicaid Fraud Investigation" to most people and they immediately envision FBI agents going after a large enterprise of greedy and sophisticated healthcare providers engaged in a complex scheme to manipulate the diagnostic codes used to claim payments.
But sometimes it's just the tragedy of a desperate older woman making a huge mistake after falling through the cracks of our very complicated healthcare payments systems.
This week a sheriff in Hamilton County, Tennessee arrested a 58 year old woman for using someone else’s benefits to pay for prescription drugs, including medications to treat high blood pressure, high cholesterol, type-2 diabetes and ulcers.
She was charged with 24 counts of fraud. If convicted, she will face a maximum sentence of up to 2 years in prison per charge.
This is a very sad case. While the government's press release refers to unspecified "muscle relaxers," the other medications involved are not the types of drugs used by addicts or sold on the street for a profit. Someone who steals medications for high blood pressure, high cholesterol, type-2 diabetes and ulcers is most likely an individual with potentially life threatening heart disease, diabetes, and other illnesses.
What if this is a woman who desperately needs medications that she cannot afford, who is a couple of years shy of qualifying for Medicare, and who either does not qualify for or needs help applying for Medicaid?
Desperation is not a justification for fraud, so we cannot pretend that this woman did nothing wrong. At the same time, it appears that this woman may have fallen through the cracks of a complex healthcare system that enriches many (thanks to government programs, the healthcare industry is adding jobs and increasing profits despite the lingering effects of the Great Recession) while not reaching many who desperately need it.
Dickens himself would probably see both the tragedy and the irony of what may happen next. If this woman is sent to prison and she really does have heart disease and type-2 diabetes, then the state will be required to pay for her medications.
John Howley, Esq.
New York, New York
But sometimes it's just the tragedy of a desperate older woman making a huge mistake after falling through the cracks of our very complicated healthcare payments systems.
This week a sheriff in Hamilton County, Tennessee arrested a 58 year old woman for using someone else’s benefits to pay for prescription drugs, including medications to treat high blood pressure, high cholesterol, type-2 diabetes and ulcers.
She was charged with 24 counts of fraud. If convicted, she will face a maximum sentence of up to 2 years in prison per charge.
This is a very sad case. While the government's press release refers to unspecified "muscle relaxers," the other medications involved are not the types of drugs used by addicts or sold on the street for a profit. Someone who steals medications for high blood pressure, high cholesterol, type-2 diabetes and ulcers is most likely an individual with potentially life threatening heart disease, diabetes, and other illnesses.
What if this is a woman who desperately needs medications that she cannot afford, who is a couple of years shy of qualifying for Medicare, and who either does not qualify for or needs help applying for Medicaid?
Desperation is not a justification for fraud, so we cannot pretend that this woman did nothing wrong. At the same time, it appears that this woman may have fallen through the cracks of a complex healthcare system that enriches many (thanks to government programs, the healthcare industry is adding jobs and increasing profits despite the lingering effects of the Great Recession) while not reaching many who desperately need it.
Dickens himself would probably see both the tragedy and the irony of what may happen next. If this woman is sent to prison and she really does have heart disease and type-2 diabetes, then the state will be required to pay for her medications.
John Howley, Esq.
New York, New York
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