Florida Group Home Manager Arrested for Stealing from Disabled Adults

By Dr. Thu Pham, O.D., Law Clerk, The Health Law Firm Attorney and George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A former employee of an organization that provides services to developmentally disabled adults in Alachua County, Florida, was arrested on June 15, 2012, according to the Attorney General’s (AG) Office. The woman was arrested for allegedly stealing money from 11 clients in 2010 and 2011.

To see the press release from the AG, click here.


Investigation Was Led by the Medicaid Fraud Control Unit (MFCU).
The woman was a group home manager at the organization that provides support to developmentally disabled adults. She was allegedly responsible for her clients’ money. In a Gainesville Sun article the associate director of the organization said it’s a policy to make monthly audits of its clients’ money. One month, at the house where this woman worked, the money did not add up.

According to the AG, the arrest came after an investigation by the Medicaid Fraud Control Unit (MFCU). She was arrested on allegations of exploiting 11 disabled adults and has been allegedly charged with stealing more than $1,300 from her clients.

If convicted, she faces up to 60 years in prison and a $60,000 fine.

To see the entire article from The Gainesville Sun, click here.


Responding to Auditing Agencies.
The MFCU receives referrals from many other state and federal agencies. Sometimes, matters that could be resolved as simple billing errors get escalated to criminal charges when Medicaid providers are interviewed and give evidence against themselves. Admitting to any misconduct, no matter how slight, may lead to far more serious criminal charges.

Click here for tips on how to respond to an audit by the Medicaid Fraud Control Unit.


Contact Health Law Attorneys Experienced in Handling Medicaid Audits.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don't wait until it's too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Sources:
Meale, Jenn. “Attorney General Bondi Announces Arrest of Alachua County Woman for Exploiting 11 Disabled Adults.” My Florida Legal. (June 15, 2012). From: http://www.myfloridalegal.com/newsrel.nsf/newsreleases/6D12D500A38B755D85257A1E006389E5


Smith, Chad. “Former Arc Employee Arrested on Exploitation Charges.” The Gainesville Sun. (June 15, 2012). From: http://www.gainesville.com/article/20120615/articles/120619706?template=printart



About the Authors: Dr. Thu Pham, O.D., is a law clerk with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

North Carolina Department of Health and Human Services (DHHS) Investigating 75 Cases of Potential Medicaid Billing Fraud

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The North Carolina Department of Health and Human Services (DHHS) announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. The DHHS has already referred 35 cases totaling $21 million to the special Medicaid Investigations Unit of the North Carolina Attorney General’s office.

Questionable Billing Practices Investigated with Data Analytics Software.

Using data analytics software from IBM, the DHHS reviewed 75 cases that showed, what it calls: “questionable billing practices by Medicaid outpatient behavioral health providers.”

The software program can allegedly detect billing behaviors that suggest fraud and can point to other related providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.

Thirteen of the referred Medicaid providers were in Wake County, four in Durham, three in Robeson and two each in New Hanover and Franklin counties. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland.

To see the full press release from the North Carolina DHHS, click here.

More Referrals Could Be Coming.

The healthcare practices were not listed by name, because they have been referred for a criminal investigation. If criminal charges are filed, the names of those being investigated would then be public record.
More referrals could be forthcoming if DHHS finds more suspicious billings.

What to Do If You Are the Subject of a Medicaid Audit.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Click here to see a complete list of steps you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process.

Don't Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Audits Now.

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Our attorneys have represented Medicaid providers in cases in North Carolina, South Carolina, Michigan, Florida, Mississippi and New York, among other states.

Our attorneys can represent healthcare providers in Medicare and Medicaid investigations, audits and administrative hearings in other states and jurisdictions as permitted by the rules governing attorneys in those jurisdictions.
Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

Sources:

Pearson, Chrissy. “Almost Three Dozen Medicaid Cases Referred to Law Enforcement.” North Carolina Department of Health and Human Services. (July 25, 2012). Press Release From: http://www.ncdhhs.gov/pressrel/2012/2012-07-25_medicaid_cases_referred.htm

DeBruyn, Jason. “DHHS investigating dozens of alleged billing fraud cases.” Triangle Business Journal. (July 26, 2012). From: http://www.bizjournals.com/triangle/news/2012/07/26/dhhs-investigating-dozens-of-alleged.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

Almost Three Dozen Medicaid Billing Fraud Cases Are Under Investiagtion By The North Carolina Department of Health and Human Services (DHHS)

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The North Carolina Department of Health and Human Services (DHHS) announced on July 25, 2012, in a press release, that it investigated 75 cases for potential Medicaid billing fraud. The DHHS has already referred 35 cases totaling $21 million to the special Medicaid Investigations Unit of the North Carolina Attorney General’s office.

Data Analytics Software Used to Discover Billing Behaviors that Suggest Fraud.

Using data analytics software from IBM, the DHHS reviewed 75 cases that showed, what it calls: “questionable billing practices by Medicaid outpatient behavioral health providers.”

The software program can allegedly detect billing behaviors that suggest fraud and can point to other related providers that may be abusing the Medicaid program. North Carolina is the first state to use the IBM software to track down Medicaid fraud.

Thirteen of the referred Medicaid providers were in Wake County, four in Durham, three in Robeson and two each in New Hanover and Franklin counties. The following counties each had one provider referred: Pitt, Orange, Onslow, Nash, Martin, Johnston, Iredell, Guilford, Granville, Franklin, Forsyth and Cumberland.

To see the full press release from the North Carolina DHHS, click here.

More Referrals Could Be Coming As the Investigation Moves Forward.

The healthcare practices were not listed by name, because they have been referred for a criminal investigation. If criminal charges are filed, the names of those being investigated would then be public record.

More referrals could be forthcoming if DHHS finds more suspicious billings.

How to Respond to a Medicaid Audit.

Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know.

The most important thing is that just because you are being audited, it does not mean that you or your business has done anything wrong. State and federal governments conduct audits for many different reasons. Typical ones include: special audits of high-fraud geographic areas, auditing of particular billing codes, randomly selected provider auditing, and complaints of possible fraud.

Click here to see a complete list of steps you should take in order to compile and provide a set of records that will best serve to help you avoid any liability at the conclusion of the audit process.

Don't Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Audits Now.

The lawyers of The Health Law Firm routinely represent physicians and other healthcare professionals in Medicare and Medicaid investigations, audits and recovery actions. They also represent physicians and health professionals in actions initiated by the Medicaid Fraud Control Units (MFCUs), in False Claims Act cases, in actions initiated by the state to exclude or terminate from the Medicaid Program or by the HHS OIG to exclude from the Medicare Program.

Our attorneys have represented Medicaid providers in cases in North Carolina, South Carolina, Michigan, Florida, Mississippi and New York, among other states.

Our attorneys can represent healthcare providers in Medicare and Medicaid investigations, audits and administrative hearings in other states and jurisdictions as permitted by the rules governing attorneys in those jurisdictions.

Call now at (407) 331-6620 or (850) 439-1001 or visit our website www.TheHealthLawFirm.com.

Sources:

Pearson, Chrissy. “Almost Three Dozen Medicaid Cases Referred to Law Enforcement.” North Carolina Department of Health and Human Services. (July 25, 2012). Press Release From: http://www.ncdhhs.gov/pressrel/2012/2012-07-25_medicaid_cases_referred.htm

DeBruyn, Jason. “DHHS investigating dozens of alleged billing fraud cases.” Triangle Business Journal. (July 26, 2012). From: http://www.bizjournals.com/triangle/news/2012/07/26/dhhs-investigating-dozens-of-alleged.html

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.