Robert West, 63, went to his dentist and was told his Medicaid benefits had maxed out, concerned at the lack of funds the disabled veteran began investigating his provider Maxim Healthcare, only to find out that they had been cooking the books.
Realizing the insurance provider had charged him for hundreds of hours in nursing care that he never actually received West began making phone calls to government agencies, he then eventually hired a lawyer when those calls were not returned.
After admitting to defrauding Medicaid and Veteran Affairs, Maxim agreed to pay $150 million and for his part West received a 10% whistleblower judgement of $15 million.
According to the Star-Ledger :
In a criminal complaint filed as part of the settlement, Maxim Healthcare, a privately held, Maryland-based medical staffing and home health care company, was charged with submitting false and undocumented claims between 2003 and 2009, as well as operating unlicensed health care staffing offices in five states.
Officials said Maxim had an incentive compensation structure, based on how much billing each office did. Those who generated more revenue were recognized and compensated. Those who did not make their numbers would be cut.
What’s even more amazing about Robert’s work is that he spent his own time combing through hundreds of documents to help prove the fraud, in the meantime state and federal officials are all trying to claim credit for the work the veteran completed on his own.
Poking fun at the system West’s lawyer said of his win and new wealth:
“He no longer qualifies for Medicaid.”
What do you think about Robert’s massive Medicaid fraud exposure?
