Ethel Bethea and Her Medicaid Fraud

Ethel Bethea and Her Medicaid Fraud

Considering the hundreds of millions of dollars that Medicaid got unethically billed for over the past few years, the fraud of $100,000, in this case, might seem rather paltry. Nevertheless, it shows an on-going pattern of healthcare providers who believe themselves to be above the law and who are rather creative in how they fleece the system.

Irregularities in Billing

Ethel Bethea of New Haven, Connecticut was a licensed drug and alcohol counselor. She has just been charged, according to the Connecticut State Division of Criminal Justice with: “first-degree larceny by defrauding a public community, health insurance fraud and 15 counts of third-degree identity theft.”

Many of Bethea’s patients, as it turns out, were not patients at all. She faked claims for people who were in the hospital, in prison, or even dead. She claimed to have counseled all of them in her office. The irregularities occurred because Medicaid investigators could not justify the billing dates for services against the situations of the supposed patients. For example, one patient was incarcerated on the dates that Bethea claimed she had provided counseling in her office. Another patient had already died in a motor vehicle accident on the dates she was alleged to have counseled that patient.

The icing on the cake was counseling dates that Bethea billed Medicaid where she was on a cruise to the Bahamas.

Fraud Thrives on a Lack of Oversite

It is not possible, of course, to determine if Ethel Bethea was an effective counselor – or not. However, as one of the cornerstones of drug and alcohol counseling is total honesty and transparency, it is certainly apparent that whatever Ms. Bethea was teaching, she was not following her own advice.

In her practice she found ways to circumvent the system, one lie at a time. We cannot determine within the context of this situation whether the fraud was limited to only the patients who were named. My guess is that she had pushed the envelope for a while until her fraud became more outrageous. Perhaps she billed for a few missed appointments, or even billed for fictitious patients here and there, before she realized that no one was looking over her shoulder. Fraud loves opportunity, and when Ethel Bethea saw those opportunities, she pounced on them.

What was her need to commit such fraud? We can easily argue that it was all about money. It was an easy way to double or even triple her income. She was billing Medicaid for patients who weren’t even there and some who would never be there. In fact, it must have been a sort of joke as she was partying on a Bahamas cruise ship while turning in bills to Medicaid. It leads me to another guess: she wanted to see what she could get away with; what she could put over on a system that she believed owed her something. In that context (as it often does), it was less about money and more about power. She was empowered to take advantage of the system. Who empowered her? Her lack of ethics.

How did Ethel Bethea, licensed drug and alcohol counselor, rationalize her behavior? How did someone who must have counseled patients to come clean and sober about their situations, turn so “blind drunk” about what she was doing? How could she rationalize it? Simply, that unlike her patients, she did not think of Medicaid as being “real,” that Medicaid was a bank with unlimited funds free for the taking. In essence, Ms. Bethea view Medicaid in much the same way as a patient who might have stolen to support a drug or alcohol problem.

The key here is ethical training, and reinforced training, as part of the ongoing requirement for licensure. Why this doesn’t occur is mysterious to me. If for no other purpose, ethical training might have reinforced what Ms. Bethea should have known: there is a choice for every consequence. In her case, the penalties will end a career and a reputation.

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