CLINTON — A Clinton woman has been charged with fraudulent practice and tampering with records.
Samantha D. Blaine, 35, 156 N. Fifth St., is charged with second-degree fraudulent practice, a class D felony, and tampering with records, an aggravated misdemeanor. Attorney Joel Saldivar was appointed to represent Blaine. A preliminary hearing is set for 8:30 a.m. Oct. 24.
According to the affidavit, on Jan. 5, a case was opened by the Iowa Medicaid Fraud Control Unit after receiving a referral from AneriHealth. AneriHealth, in their referral, detailed a concern that Blaine, a Consumer Choice Option provider, was documenting and billing for transportation services when she did not have a valid driver’s license. During a prior interview, Blaine reportedly admitted her mother was the one who actually provided the transportation services.
Blaine also reportedly stated once she was paid for the transportation services, she would turn the money over to her mother. A second concern was Blaine had also documented and billed for Consumer Choice Option services she provided services to a family member, which overlapped with times that either Blaine was at work or the family member was receiving services from another company.
The affidavit states Blaine’s family member is a Medicaid member who receives services through the SCL and respite programs, which are funded by the Iowa Medicaid program. Blaine had been an approved provider of SCL and respite services to the family member since Feb. 12, 2015. Blaine during this time also worked at Hardee’s restaurant on a consistent and regular basis. Records showed Blaine had not had a driver’s license since at least June 28, 2013.
The affidavit continues a review and comparison was completed of the time records from Veridian Credit Union (SCL and respite services) and time cards from Doro (Hardee’s). It was determined at that time that on 20 separate dates between Jan. 18, 2016, and Nov. 2, 2016, Blaine had documented she was providing SCL or respite services when she was actually working at Hardee’s. The documentation of over 72.25 hours of services that were not provided allegedly created a fraudulent billing to the state of Iowa of $1,156.
The affidavit states Blaine’s mother was contacted regarding the transportation services. The mother at that time admitted she was the one who provided the transportation services because Blaine did not drive. She also admitted Blaine would document and bill the Consumer Choice Option program for the transportation services but then give the money to her. The mother stated Blaine would document and bill the state for the transportation services and then pay her the money in cash.
The investigation also allegedly found that on 193 days over a 10 month period Blaine documented and billed for transportation services she did not provide. The amount of the fraudulently billed transportation services was $1,115.58. The total amount identified as being allegedly fraudulently billed was $2,271.58, for which the state of Iowa is requesting restitution.
The Medicaid Fraud Control Unit is requesting recovery of investigative costs as authorized by Iowa Code. The total costs as of March 22 were $1,174.50. The total amount of requested recovery is $4,046.08, the total value identified as being stolen combined with the total investigative case costs.