Welfare Fraud

RNBSN1591 · Dec 21, 2015

I would be frustrated, but wonder what loopholes they might be exploiting. Who's name are the rental properties in? Who's name is their house in? Are the designer clothes and shoes "gifts"? Unfortunately, it seems like there are a lot of legal ways to commit fraud. Good luck.

Thanks ms for the validation. The husband shops at Lowes and Costco. He has every tool you can buy. Their fridge is always stocked, with very expensive stuff. I saw an AMEX bill for $4500 paid. I know their income because I saw it written. They leave stuff like that out, along with their budget info. That's how I know their income. She's very open about the fraud, and the SS for the husband child will exceed what I make in a month. Our state is stupid; if you don't report on application they don't check. Normally I don't care about things like this, but this is OVER THE TOP. Their sense of entitlement is astounding; I usually see pt fighting for needed supplies, but she has triple supplies than any other pt I have worked for. Thanks for the validation. I think the properties go thru the brother in law. Thanks all.

Pangea Reunited, ASN, RN · Dec 21, 2015

Grrrr, I mean "Whose" but it's too late to edit. :no:

PinayUSA · Dec 21, 2015

You can try to report it, But more than likely it wont matter.

xoemmylouox, ASN, RN · Dec 21, 2015

Some states have certain medicaid plans for more than just income issues. Some children are qualified based on diagnosis. Make sure this isn't the case for your pt's family. I agree that we see a lot of fraud as well. It infuriates me. We report it when we can, but often nothing comes of it. In fact we reported that a family had MOVED out of state yet were using a relatives address for their benefits. Still waiting on Medicaid to do something about that one.

CryssyD · Dec 21, 2015

I will probably take a lot of heat for this, but it would be interesting to know more about how exactly they are gaming the system. I say that because, as another poster pointed out, their apparent "deceptions" may be morally questionable but perfectly legal.

Sadly, in today's economic and political environments, those who hire fancy tax attorneys to help them exploit every conceivable tax loophole to ensure that as little possible of their money goes to the government are often admired and praised for their cleverness in stiffing Uncle Sam; meanwhile, those who take advantage of similarly legal, if somewhat shady, maneuvering to extract as many benefits from social programs as possible are castigated as shameless leeches with "a sense of entitlement." I'm sure we can all agree that actual fraud is repugnant; however, the line between fraud and legal shrewdness is not always as clearly drawn as we would like to believe.

Again, I'm personally against all shady legal maneuvering: pay your fair share like a grown-up, and don't use up benefits you don't actually need. Sadly, far too many people on both sides of the economic spectrum suffer from an overweening "sense of entitlement." As usual, it's the responsible, middle-class working stiffs who wind up carrying the biggest load and reaping the smallest proportion of the rewards.

Just sayin.'

JustBeachyNurse, LPN · Dec 21, 2015

There are Medicaid waivers for medically complex children especially for private duty nursing and certain therapies. Private insurance rarely covers true private duty nursing so Medicaid picks up rather than have a child placed out of home in a pediatric LTC or medical day school.

FolksBtrippin, BSN, RN · Dec 26, 2015

I don't think this is the type of thing you should "report" for a couple of reasons. 1. You really should not know their financial info. You're the nurse, not the accountant. It's not your business, even if they told you. You should not be providing this info to other people that you never should have had in the first place. If they left their credit card bill where you could see it, you should not look. If you happen to see it, you should pretend you saw nothing. If they try to show/tell you financial information you should stop them from doing so. It is truly, truly not your place. For this reason, there is nothing to report. Do you really want to take a picture of their financial info and send it to some authority? Think about this hard. Is that why you are in their house? To be looking at their credit card statements? I think not. 2. This does not fall under the type of reporting you might be legally mandated to do. If your agency was billing for services that were never provided, that would be something you should report. That is clear fraud and involves you. This has nothing to do with you and it might not even be fraud. All you know is that you see expensive shoes and you hear about high income and you saw a credit card bill that you should not have seen. No. This is not your place. I think the best thing that could happen if you report it is nothing. The worst thing is that you get yourself in a hot mess for invading your client's privacy while on the job. If your suspicions are a problem for you, just get another placement.

One more thing: If you were my employee and came to me with info like this I would very likely fire you.

RNBSN1591 · Dec 30, 2015

That is why I came here for advise. I do not snoop, the patient is very forthright about lying to obtain services. The things that I saw were in plain sight. I see a gross abuse of the system and I am conflicted. That's why I came here. And my CNA boss has committed fraud by telling coworker it's ok to bill more hours than worked. Blatant fraud. It's obvious that they are living beyond their so called status. I did not report. But if you were in the home, you may see it differently. If I were your employee, I would not bring it to your attention anyway. You do not see what I see, not designer shoes. I see someone who is defrauding a system that others desperately need and do not get. I do not believe in lying; it's a a morality issue. Would you tell on classmates that are cheating? Same argument. Saw that, kept mouth shut d/t bad teacher. You wear your shoes, I'll wear mine.

RNBSN1591 · Dec 30, 2015

The child/ father will receive $3500 a month until she's 18. Under 9 now.

beckysue920 · Dec 31, 2015

If you choose to report it, I would do it anonymously. Plus I would not let anyone know your thoughts on this couple's transgressions, which, IMHO are deplorable as well as criminal. You don't want anyone broadcasting your intentions/actions, which may bite you in the butt.

Unfortunately, from my experience, I have found an anonymous complaint rarely produces results...unless I happened to be dealing with a "who cares" governmental system (resulting in a 'no action' taken).

I wish you luck and hope to 'hear' what you decided to do.

sissiesmama, ASN, RN · Dec 31, 2015

Yes, report it ASAP. It's people like that family who make it hard for those of us with legitimate needs. Shame on them!

No doubt! I agree Viva! Shame - I would love to have assistance with things but am not able.

Anne

MunoRN, RN · Dec 31, 2015

The child/ father will receive $3500 a month until she's 18. Under 9 now.

If you have knowledge of fraud I would report it and let them figure out exactly how much they've been stealing, but the amounts you're suggesting aren't really possible. First, there are no welfare programs that would provide $3500 a month for an adult and child, more like $600 for "welfare" (TANF). And they don't offer welfare, food stamps, etc for that sort of time duration, they would have to requalify at least yearly. What you're describing sounds more like life insurance payments.