Federal law enforcement officials on Thursday announced that two Ohio state employees and two co-conspirators were indicted in connection with an alleged $30 million Medicaid billing fraud scheme involving children’s behavioral health services that were never rendered.
At a press conference in Ohio, acting Attorney General Todd Blanche said the Medicaid fraud case was just one of several cases unsealed over the last week targeting some $50 million of fraud, including one case involving a $1.4 million COVID-19 loan fraud scheme.
All four defendants involved in the Medicaid fraud case turned themselves in to authorities this week, a source familiar with the investigation told CBS News.
As part of the investigation, 14 vehicles were seized, including a Maserati, a Mercedes, a Bentley and a McLaren, according to the source.
The defendants are alleged to have offered therapeutic behavioral…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.