Healthcare News & Insights

Disabled vet blows lid off multi-million dollar Medicaid fraud

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For his efforts uncovering a Medicaid fraud that the government couldn’t, the veteran pocketed a $15 million whistle blower payout.

Richard West, a 63-year-old Vietnam vet living in New Jersey knew something was wrong when medical services he needed were being cut back because he had supposedly reached the spending limit. West has muscular dystrophy, is confined to a wheelchair and needs oxygen — but he’s nobody’s fool and knew the numbers didn’t add up.

A little digging into his records showed that Maxim Healthcare had overbilled for hundreds of hours of care he never received, from nurses he’d never met.

West contacted numerous federal agencies who all declined to help him. So he hired his own lawyer and went to court.

When all was said and done, Maxim had agreed to pay the highest financial settlement in history for home healthcare fraud: $121.5 million in reimbursements and penalties, $8.4 million to the Veterans Administration and a fine of $20 million. Under the whistle-blower laws, West gets to keep a cool $15 million of that. He said he plans to use the funds to buy a new van, make some improvements to his home and donate to charities for the disabled. He will however, lose his Medicaid eligibility as his lawyer noted.

What motivated him to keep up the fight? West told a reporter for the New York Post: “The more I uncovered, the more pissed off I got that someone was making money on my disability… From my wheelchair, on a ventilator and oxygen, I have spent the last seven years in this fight. Sometimes the good guy wins.”

  • ed smith

    OH ….The irony of this case. A disabled veteran with physical and financial limitations had the tenacity to uncover this massive case of governmental waste and fraud. Unfortunately many public servants would rather take the path of least resistance,( ie those that refused to investigate Mr. West’s suspicion of wrongdoings). They (civil servants) soon forget that they are paid a salary to carry out the mandate of their jobs and folllow up on citizen’s concerns,another example of gross incompetence is the Duggards’ abduction case in California. Mr West is to be saluted for staying the course, but Im sure he would have rather spent the time managing his everyday health care needs.

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