Remembering Richard West, Medicaid fraud whistleblower

Taxpayers Against Fraud reported last month the passing of Richard West, a disabled Vietnam War veteran and Medicaid recipient who successfully exposed fraud by Maxim Healthcare, the provider of his home healthcare services. West, who had muscular dystrophy, was in a wheelchair and on a ventilator when he filed a False Claims Act (or qui tam) case against Maxim in a New Jersey court. Ultimately, the case recovered  $150 million for taxpayers. West received a reward of $15.4 million for his efforts in documenting and pursuing the claim.   West’s story is an inspiration for other healthcare recipients, especially those with disabilities, who may feel they are at the mercy of dishonest companies. West testified at a 2011 Congressional hearing (video above) on Medicaid fraud, waste and abuse.

I received home health care and other services through the Community Resources For People With Disabilities Medicaid Waiver program. As a ventilator wheelchair and oxygen-dependent person, I qualified for the government-funded program that provides Medicaid benefits up to 16 hours per day of in-home nursing care. There’s a limit on the services under this program each month, and benefits may be suspended or reduced if the monthly cap is exceeded.

Beginning in March 2003, I received home health care through Maxim Health Care Services under this program. Maxim billed the home health care services to Medicaid which paid for them with both State and Federal funds. In September 2004, I received a letter from the New Jersey Department of Human Services Division of Disability Services Home and Community Services telling me that I had exceeded my monthly cap and that my Medicaid services were being temporarily reduced or suspended as a result. This prevented me from obtaining needed dental care.

Maxim was overbilling and under delivering basic services to America’s oldest, sickest and poorest. The goal was not to provide better services and products at lower prices, but rather to see if they could take advantage of weak Medicare and Medicaid oversight, to see if Uncle Sam could be ripped off and no one noticed, to see if patients who complained would not be taken seriously or would give up after a few calls to Medicaid. And guess what They were right. Maxim’s game went on for years and America’s taxpayers were systematically ripped off. But not only were taxpayers ripped off, when corporations rip off Medicare and Medicaid there are other victims besides taxpayers. Maxim took services from people like me.

—Richard West

West’s fight against fraud was recognized with the Christopher W. Hohenstein Fraud Fighter of the Year by the Association of Certified Fraud Examiners (2012) and the VFW Americanism Award (2013). He received multiple awards for his advocacy of disability rights, including the Lifetime Advocacy Award by Community Quest (February 7, 2008) and the Community Building Award by The New Jersey Council on Developmental Disabilities (2012). Richard West was 65 when he died at his home in Tuckerton, NJ, on March 14. The family suggests making donations in his name to Disability Rights New Jersey, Parent Project Muscular Dystrophy, or Homes for Our Troops.