There are an abundance of reports of health care and disability fraud prosecutions in workers’ compensation, personal injury, Medicare and other programs. It is not widely known that prosecutors have now opened investigations on 111 suspected fraudulent Veteran disability claims as well.
The Veteran’s Benefits Administration provides a number of financial benefits programs for eligible veterans and certain family members, including monetary benefits for service connected disabled veterans. Investigations routinely concentrate on payments made to ineligible individuals. For example, a veteran may deliberately feign a medical disability to defraud the VA compensation program.
According to a Department of Veterans Affairs Office of Inspector General report, VA investigators opened 111 health care cases during the first six months of this fiscal year and were able to obtain more than $125 million in court ordered fines and restitution.
In one illustrative case, reported by KSAT television, it was subrosa surveillance that provided the necessary evidence for a conviction.
The United States Department of Justice released footage showing an Army veteran who told doctors he could no longer walk – mowing his lawn and walking around his front yard. The footage, gathered over several months by undercover investigators with the Department of Veterans Affairs Office of Inspector General, was used in June to convict 54-year-old Mack Cole Jr. of federal health care fraud and making false statements about a health care benefit program.
Cole was convicted after federal prosecutors convinced a jury that he exaggerated the extent and severity of a lower back injury for more than seven years in order to get “inflated payments” from the Veterans Affairs Disability Compensation Program.
By misrepresenting the scope of his injuries, Cole was able to receive a higher level of benefits, adaptations to his home and durable medical equipment, according to the U.S. Attorney’s Office.
Cole, a retired Army master sergeant, remains free on bond while awaiting sentencing in September. He faces up to 50 years in prison.
Among the clips is footage of Cole being pushed in a wheelchair outside of the San Antonio VA hospital. Other clips show Cole pushing a lawn mower up hill in the front yard of his Cibolo home, at one point bending down quickly to toss away debris.
The footage stands in stark contrast to statements Cole made to VA doctors about his back injury following a National Guard training incident in 2004. According to Cole’s federal indictment, he told doctors in November 2010 he no longer had “any ability to walk” and “dreams of walking again.”
Five months later, he said he “no longer walks because of fear of further impairment and last walked in January of 2011.” In October 2011, Cole said he was “unable to raise (his) leg and (was) not walking at home.”
Cole’s case is part of a nationwide increase in VA fraud investigations. There does not appear to be any benefit system that is immune to the onslaught of claims presented by fraudulent beneficiaries. And subrosa investigation remains a potent tool in fleshing out exaggerated claims.