Health Care Fraud Earns Irene Anderson A 46 Month Federal Prison Sentence! Fraud Prevention Expert Chuck Gallagher Questions Motives…

February 16, 2009

What motivates fraudulent behavior?  Are fraudsters basically bad or do good people make poor choices which leads to fraud?  These are questions seem to asked daily as new reports surface of indicted or sentenced fraud.

Seems that Irene Anderson, 45, of Wylie, Texas, was sentenced to 46 months in federal prison and was also ordered to pay $2,276.622.31 restitution,  prison1forfeit a 2006 Hummer, a 2002 Suzuki and $8500 in cash that was found in her car when she was arrested on April 18, 2008.   Not only is a 46 month prison sentence significant, but returning to society as a convicted felon and owing over $2 million in restitution would be an obstacle that would seem insurmountable.

According to the US Attorney’s news release:

Beginning in February 2005 and continuing until May 2008, Anderson operated a scheme to defraud the U.S. Department of Health and Human Services and Medicare by applying for and obtaining a Medicare provider number for her home health agency, New Dimension, falsely representing that New Dimension was owned by “Iya E. Edwards.”

Iya Edwards, dba New Dimension was issued a Medicare provider number in March 2005 and from approximately March 9, 2005 to April 21, 2008, Anderson billed Medicare for services using that number. Throughout this period, Anderson continued to falsely represent to Medicare that the owner of New Dimension was Iya Edwards rather than Anderson, causing Medicare to pay New Dimensions a total of $1,188,698.74 because of her scheme. Anderson also fraudulently obtained in excess of another $1 million in Medicare funds paid to AG Total Care for home health visits that Anderson never made. These payments are included in the Court’s restitution order of $2.2 million.

According to a Fox News report at sentencing, “Irene Anderson sobbed in federal court as she pleaded for mercy. The Nigerian national told Judge Jane Boyle she was just trying to make a better life for her family. But the judge said she has seen few government scams involving this much money.”

In order to effect a fraud three components must be present:  (1) need, (2) opportunity and (3) rationalization.  It appears from Irene’s comment that her rationalization was creating a better life for herself and family.  The question however is why would she feel that theft thru fraud is the appropriate way?  She was reported as a Nigerian national.  Is it possible that based on her background that fraud is an acceptable method of getting ahead?

Every choice has a consequence.

There is a difference between making a bad choice and choosing to intentionally do wrong.  In this case there appears to be no indication of anything other than intentionally doing wrong.  This goes beyond unethical behavior to down right fraud.  Not only did Irene get an active prison sentence, but there had to be other casualties of her actions.  From wanting to help her family to spending time away from them in prison, one wonders the how and why of such an action.

However, so as not to sound judgmental – I openly admit that I did the same thing.  I made choices that had painful consequences and left a scar on my life that will never be forgotten.  Yesterday I had the privilege to speaking to a convicted felon who was recently released from prison.  I shared with her something that has sustained me on my journey following:  The choices you make today will define your life in the future.  Choose wisely!  We can elect to be a victim and be defined by our past or we can make different choices and create a life moving forward that is empowering – not only to ourselves but to those we touch.

Perhaps Irene will learn from her past choices and make those that will be uplifting in the future.