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MADISON — I was recently reminded about the impact that concerned citizens can make in the operation of their own government. In two separate cases, eventually prosecuted by my office, people with no direct financial incentive or reward provided critical information that led to convictions for criminal acts of Medicaid Fraud.
Medicaid is the healthcare assistance program for our neediest residents. Among other important services, the program provides nursing care for homebound and disabled individuals. The intent is to help people to remain in their own homes to preserve their dignity and to avoid the significant expense of inpatient care. But it can only work if care providers and recipients follow the program regulations. When providers exploit the system, we hold them accountable, but we need your help to do that.
In the first case, Catherine Lipke of Sparta told one of the investigators in my office that a registered nurse participating in a Medicaid program called “Nurses in Independent Practice” was billing Medicaid for services to her disabled daughter that were never actually provided. Ms. Lipke provided copies of calendars, nursing notes and medication records that helped with the investigation into the fraudulent claims that were being submitted by the in-home nurse.
After a thorough investigation and aggressive prosecution, the nurse was convicted of three counts of Filing Fraudulent Claims. Her sentence was withheld, and she was placed on two years probation. As conditions, she was ordered to serve six months on electronic monitoring, maintain employment, attend financial planning education and training, and to pay $37,890.32 in restitution to the Medicaid program. Ms. Lipke had nothing to gain other than the satisfaction of helping to protect the taxpayer dollars needed to provide legitimate services to deserving recipients.
In the second case, Marsha Holler of Sheboygan and private duty nurse Allison Aschenbach of Plymouth reported to the Department of Regulation and Licensing (now the Department of Safety and Professional Services) and to my investigator about the activities of a contract nurse who was billing the Medicaid program for dates and times that she was supposedly providing services for Holler's disabled daughter, but which overlapped with hours she was working at Aurora Hospital. Again, further investigation verified the information and was used as a basis for criminal charges against the provider.
The nurse argued that she was using a process called “creative billing” in which she billed for one recipient but actually provided services to another. No sale. She was charged and convicted of Medicaid Fraud. Her sentence was withheld, and she was placed on three years probation, with conditions that she serve 90 days in jail and pay restitution in the amount of $48,109. Again, neither Ms. Aschenbach nor Ms. Holler had reason to report the fictitious billing other than their sense that it was the right thing to do.
Catherine Lipke, Marsha Holler, and Allison Aschenbach are real-life heroes who deserve our thanks and admiration. With nothing to gain but inconvenience and hardship for themselves, they did what was right to protect the integrity of our Medicaid program. The vast majority of Medicaid providers are honest and hardworking professionals who do not game the system. Those providers also deserve our thanks. However, as long as the dishonest minority continues to take money from those in need, we need your help.
If you have any information to suggest fraudulent activity by any Medicaid providers, please call our hotline at 1-800-488-3780.