RX for Fraud

Health care suspicions? Better call a fraud examiner



In an episode of the popular television crime drama “Better Call Saul,” a lawyer stumbles upon a case of health care fraud. In real life, fraud examiners are leading the fight against these types of widespread fraud schemes by gathering evidence, analyzing documents and separating fact from fiction.

Irene Landry hears a knock at the door. To her delight it’s her charming lawyer, Jimmy McGill, paying a visit at her nursing home, Sandpiper Crossing. They spend the afternoon drafting her will while they snack on Hydrox cookies. A few signatures and they call it a day — a $140 day, that is. Irene counts the bills folded in her yellow purse and walks over to a tin can resting on the book shelf. She uncomfortably laughs. She only has $43 until her allowance next week. Jimmy laughs, too — also uncomfortably. He’s confused as to why she’s on an allowance because he’s well aware of her Social Security and pension benefits. She explains the checks go directly to Sandpiper, which then distributes the money to her in a monthly allowance of $500 after fees and expenses. She pulls out a statement and hands it to Jimmy. He’s troubled by what he sees and asks Irene for more statements. He can’t believe the prices are correct.

Lo and behold, Sandpiper was systematically overcharging its residents and depriving them of their well-earned and deserved retirement money. Fortunately, this drama wasn’t unfolding in a real nursing home. It was the storyline of an episode of “Better Call Saul,” a popular TV show. This doesn’t happen in real life — or does it?



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