Deeper Than the Headlines: State Enforcement Actions to Watch
compliance, Medicaid, compliance officers, healthcare billing fraud, deeper than the headlines, healthcare fraud, medicaid billing fraud, fraud, Medicaid Fraud, Medicaid Fraud Control Units, state enforcement, treatment related fraud, fraud takedown, waste and abuse, Medicaid Fraud and Abuse
Every now and then we’ve reported on enforcement actions happening at the state level. As compliance professionals, we’re often drawn to the biggest headlines which most often occur because of federal enforcement. And we should continue to pay attention to those results.
But don’t forget that many states are becoming more active in their enforcement efforts in healthcare fraud, waste and abuse. Periodically checking in at the state level is also important.
Let’s look at some recent enforcement at the state level:
Attorney General Andy Beshear and the Office of Medicaid Fraud and Abuse announced charges against a Kentucky woman for Medicaid fraud.
They alleged that Susan E. Reed, 60, caused fraudulent documents to be submitted to the Kentucky Medicaid Program resulting in a loss to Medicaid of over $10,000.
AG Beshear said, “My office takes our role as Medicaid watchdog seriously. Those who wrongly take from our state programs that are intended to help our most vulnerable will be convicted and held accountable.”
Reportedly, Reed worked as an art and behavioral therapist. The allegations include falsely completed documents claiming services were provided to Medicaid patients when they were never offered.
Missouri Attorney General Josh Hawley recently announced that a joint-state and federal investigation led to the guilty plea of Melissa Denise DeLap, 49, of Columbia. Ms. DeLap plead guilty in federal court to health care fraud.
DeLap was contracted as a community registered nurse to provide services to four beneficiaries at a residence operated by Second Chance Homes in Fulton, Mo. Second Chance Homes submitted monthly claims to Medicaid for these services. Her duties included face-to-face evaluations, reviewing physicians’ orders, monitoring medications, and reviewing records. Carl DeBrodie, who died in September 2016, but was not reported missing until April 2017, was among the beneficiaries. From at least September 2016 through March 2017, DeLap completed and signed DeBrodie’s Community RN Monthly Health Summary, falsely stating that she had performed a face-to-face assessment of DeBrodie. She did not provide the services, for which she received payment from Medicaid, to the other three beneficiaries, as well.
DeLap must pay $106,795 in restitution to Medicaid. Within six months, she must also surrender her nursing license and not seek a nursing license in any state or territory of the United States. DeLap is subject to a sentence of up to 10 years in federal prison without parole, under federal statutes.
Three people were indicted in connection with a scheme to fraudulently bill the state’s Medicaid Program (MassHealth) for personal care attendant (PCA) services that were not provided. This was announced by Attorney General Maura Healey.
The individuals who were indicted include Kerry Quinn, age 25, Mark Ferreira, age 31, and Kariann Tomer, age 23.
The AG’s Office alleges that between March 2017 and May 2018, Quinn, who MassHealth has recognized as eligible for the PCA Program, knowingly submitted false claims to MassHealth for services more than $40,000. PCAs are paid by MassHealth to help provide basic health services and assist disabled beneficiaries with activities of daily living. Quinn named Ferreira, and later Tomer, as her PCA at different points while using this program.
The AG’s office alleges that neither Tomer nor Ferreira provided PCA services, nor could have, as the PCA timesheets submitted by Quinn directly conflicted with the timesheets and schedules of Tomer’s and Ferriera’s other full-time jobs. The AG’s office further alleges that Quinn claimed PCA benefits while traveling abroad.
Quinn allegedly informed MassHealth that both Tomer’s and Ferreira’s addresses were the same as her own – to have debit cards loaded with payment meant for PCA services sent directly to her. Quinn then allegedly received the money intended for her PCAs and unlawfully kept most of the received money for herself, in agreement with Tomer and Ferreira. Surveillance video from ATM transactions shows Quinn and her husband using one of the PCA debit cards to withdraw money.
Earlier in August, Arkansas Attorney General Leslie Rutledge announced the arrest of a Washington County woman.
Ashley Renee Beeks, 26, was accused of stealing oxycodone pills while working at a Fayetteville nursing and rehabilitation facility in December 2017. Following an investigation by the Attorney General’s Office, Beeks turned herself in to the Washington County Sheriff’s Department. She is charged with one count of obtaining a controlled substance by fraud.
Warning others, Attorney General Rutledge said “Arkansas has been devastated by the opioid epidemic. I will prosecute people such as Beeks who steal patients’ medications and abuse the system.”
Clearly, it’s not just the feds who are ramping up enforcement. Keep an eye on your state’s enforcement as well.