Category: MM Curator

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: The NY home health agency pocketed the extra money it was supposed to give to workers. $2M of it.

 
 

Clipped from: https://ag.ny.gov/press-release/2022/attorney-general-james-secures-over-3-million-home-health-agency-cheating-workers

White Glove Community Care Fraudulently Obtained More Than $1 Million
in Medicaid Funds and Failed to Pay Required Wages to Employees

Company Agrees to Pay $1.2 Million to Medicaid Program
and
Return $2 Million to Current and Former Employees

NEW YORK – New York Attorney General Letitia James today announced two agreements with White Glove Community Care, Inc. (White Glove), a Brooklyn-based home health agency, for causing false claims to be submitted to Medicaid and cheating employees out of hard-earned wages. Under the agreements, one reached with the Office of the Attorney General’s (OAG) Labor Bureau and the other with OAG’s Medicaid Fraud Control Unit (MFCU), White Glove will return $2 million in unpaid wages to workers and pay $1.2 million to the New York State Medicaid Program (Medicaid). White Glove has admitted to wrongful conduct. The United States Attorney’s Office for the Eastern District of New York (EDNY) is also party to the settlement resolving White Glove’s Medicaid fraud liability.

“Home health aides work tirelessly to provide critical care for our most vulnerable neighbors, and they deserve to receive adequate and fair compensation for their hard work,” said Attorney General James. “White Glove cheated their employees, and they cheated the everyday New Yorkers whose tax dollars fund the Medicaid program. My office will always stand up against bad actors, and ensure all workers get fair pay for their work.”

“The arduous work that these aides do, day after day, ensures that some of our most vulnerable neighbors receive the care and are shown the dignity that they deserve,” said United States Attorney Peace. “This settlement — the third in our continuing investigation of certain licensed home care service agencies — reflects this Office’s ongoing commitment to providing home health aides the hard-earned benefits guaranteed them under New York law and the Medicaid program.”

The New York Wage Parity Act sets wage and benefit minimums that state-licensed home care services agencies (LHCSAs) are required to pay to employees who perform home health aide and personal care services to Medicaid recipients. Under the law, workers are entitled to a base wage of $17.00 per hour, paid by the agencies, in New York City, Nassau, Suffolk, and Westchester counties, or $15.20 per hour for the remainder of the state, and an additional fringe benefit of $4.09 per hour in New York City or $3.22 per hour in Nassau, Suffolk, and Westchester counties. The Medicaid program reimburses LHCSAs for the cost of services provided to Medicaid recipients, and reimbursement is conditional on the agency’s compliance with the requirements of the Wage Parity Act.

The joint investigation by OAG and EDNY found that White Glove failed to pay its home health aides and personal care aides the required wages and benefits owed to them pursuant to the Wage Parity Act; sought payment from Medicaid and received money for care performed by aides who were underpaid; and falsely certified compliance with the Wage Parity Act.

Between March 2012 and December 2018, White Glove underpaid its home care aides. As a result of the settlement announced today, White Glove will pay a total of $2 million to OAG for distribution to current and former employees.

White Glove will also revise company policies and procedures; train personnel on updated policies subject to OAG’s approval; and regularly report staff wages and policy implementations to OAG for a period of three years. If White Glove fails to comply with these terms or properly compensate its aides, OAG has the authority to bring a civil action against the agency and demand $15,000 in damages for violating its legal obligations.

White Glove will also pay more than $1.2 million to the Medicaid Program, of which $758,425.47 will go to New York state. The remaining $505,616.98 will be paid to the federal government.

The OAG and EDNY commenced these investigations after whistleblowers filed a complaint under the qui tam provisions of the New York False Claims Act and the federal False Claims Act in the United States District Court for the Eastern District of New York. The New York False Claims Act allows individuals to file actions on behalf of the government and share in any recovery. The state has since filed a notice of intervention against White Glove for the purposes of settling its Medicaid fraud claims.

Attorney General James thanks United States Attorney Peace and EDNY for their collaboration on this matter.

MFCU’s total funding for federal fiscal year (FY) 2023 is $65,717,936. Of that total, 75 percent, or $49,288,452, is awarded under a grant from the U.S. Department of Health and Human Services. The remaining 25 percent, totaling $16,429,484 for FY 2023, is funded by New York state. Through MFCU’s recoveries in law enforcement actions, it regularly returns more to the state than it receives in state funding.

This matter was handled for MFCU by Special Assistant Attorneys General Ting Ting Tam, Jill D. Brenner, and Hillary G. Chapman under the supervision of MFCU Civil Enforcement Division Chief Alee N. Scott. The cases were investigated by Principal Auditor Investigator Milan Shah and Auditor-Investigator Khristian Diaz under the supervision of Regional Chief Auditor Stacey Millis. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. MFCU is a part of the Division for Criminal Justice, led by Chief Deputy Attorney General José Maldonado.

This matter was handled for the Labor Bureau by Assistant Attorneys General Anielka Sanchez Godinez and Kristen Ferguson with the assistance of Civil Enforcement Section Chief Fiona J. Kaye and Former Civil Enforcement Section Chief Ming-Qi Chu, under the supervision of former Deputy Bureau Chief Julie Ulmet and Bureau Chief Karen Cacace. Additional Assistance was provided by Data Scientist Chansoo Song and Deputy Director Megan Thorsfeldt of the Research and Analytics Department. The Labor Bureau is a part of the Division for Social Justice, which is led by Chief Deputy Attorney General Meghan Faux.

Both the Division for Criminal Justice and the Division for Social Justice are overseen by First Deputy Attorney General Jennifer Levy.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: States (and their counties) continue to not use the fraud fighting tools available to them.

 
 

 
 

Clipped from: https://www.13abc.com/2022/12/13/ohio-medicaid-ripped-off-millions-counties-could-have-stopped-it-auditor-says/

 
 

A report from the Ohio Auditor of State found that county offices are not reacting to alerts, that Medicaid recipients may be getting payments and benefits from multiple states.

CLEVELAND, Ohio (WOIO) –The Ohio Auditor of State released a report Tuesday looking into Ohio Medicaid recipients who have been getting payments and or benefits, from multiple states which is not allowed.

Auditor Keith Faber says counties, who sign up and review Medicaid recipients had been getting alerts from the federal level when people were identified as “double dippers.”

Alerts are sent to each county by a program called Public Assistance Reporting Information System (PARIS), a monitoring program aimed to catch people enrolled in multiple states.

Since following the alerts in July of 2022, the auditor’s office claims 59% of the alerts were not acted upon meaning several Ohio Medicaid recipients continued to get benefits from multiple states.

According to the report, failure to act cost Ohio and taxpayers somewhere between $5.3 million and $24.5 million annually.

“There continue to be ongoing oversight issues in Ohio’s Medicaid programs that should have been addressed,” Auditor Faber said. “It’s past time to deal with these problems.”

There are approximately 2.9 million Ohioans enrolled in Medicaid who are lower income residents, older adults, individuals with disabilities, pregnant women, infants and children, and others.

According to a news release from the auditor’s office, “Tuesday’s report follows a separate audit released in January 2022 that found the Ohio Department of Medicaid (ODM) failed to recoup more than $118.5 million in erroneous duplicate payments or improperly paid for the managed care of prison inmates and deceased residents over a three-year period.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: You paid $2.6M for this guy in CT to bill Medicaid for services not rendered, including to dead patients, or patients who were in the hospital at the time and could not receive his services. Oh yeah- he got kicked out of Medicare 15 years ago for fraud, but Medicaid was happy to pay him.

 
 

Clipped from: https://www.justice.gov/usao-ct/pr/greenwich-psychologist-admits-defrauding-medicaid-medicare-and-private-insurers

Vanessa Roberts Avery, United States Attorney for the District of Connecticut, Phillip Coyne, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of Inspector General, and David Sundberg, Special Agent in Charge of the New Haven Division of the Federal Bureau of Investigation, today announced that MICHAEL LONSKI, 71, of Greenwich, waived his right to be indicted and pleaded guilty yesterday before U.S. District Judge Sarala V. Nagala in Hartford to health care fraud.

According to court documents and statements made in court, Lonski is a licensed psychologist who, along with another licensed psychologist (“Individual 1”), has operated a practice out of his home office in Old Greenwich.  Lonski and Individual 1 were authorized providers for the Connecticut Medicaid program (“Medicaid”), Medicare and other health care benefit programs.  Lonski assumed responsibility for submitting claims for reimbursement for services allegedly provided by himself and by Individual 1, both at their home office and at various skilled nursing facilities within Connecticut.

In pleading guilty, Lonski admitted that he billed insurers for services that he knew were not rendered, including by billing for patients who were deceased, for dates of service when he was out of the country, for dates of service when Individual 1 was out of the country, and for dates of service when he was hospitalized.  These fraudulent claims resulted in a loss of over $2,651,296, including a loss of $1,157,292 to the Connecticut Medicaid program and a loss of $119,092 Medicare.

Health care fraud carries a maximum term of imprisonment of 10 years.  Judge Nagala scheduled sentencing for March 10.  As part of his plea, Lonski has agreed to pay full restitution.

Lonski is released on bond pending sentencing.

In 2002, Lonski settled a federal lawsuit alleging health care fraud offenses, which was brought by the government in the Southern District of New York.  Lonski agreed to pay $4 million in restitution and was excluded from participating in the Medicare program from April 2003 to November 2007.  He was reinstated to the Medicare program in approximately December 2008.

This investigation has been conducted by the U.S. Department of Health and Human Services, Office of the Inspector General (HHS-OIG), and the Federal Bureau of Investigation. The case is being prosecuted by Assistant U.S. Attorney Susan L. Wines.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: You paid $224k for bogus Medicaid claims to a mental health clinic in Illinois.

 
 

Clipped from: https://patch.com/illinois/beverly-mtgreenwood/owner-beverly-medical-center-charged-224k-medicaid-scam-raoul

Crime & Safety

Easter Jean Watson faces theft, fraud and forgery charges after officials said she submitted claims for psychotherapy services not provided.

 
 

Jeff Arnold,

Patch Staff

 
 

Posted Wed, Dec 14, 2022 at 12:05 pm CT

 
 

The owner of a Beverly-based mental health clinic fraudulently submitted Medicaid claims for psychotherapy services she never provided, according to criminal charges brought by the state’s Attorney General. (Shutterstock)

CHICAGO — A 74-year-old Chicago woman and owner of a Beverly-based mental health clinic faces criminal charges after prosecutors said that she filed nearly $225,000 in false Medicaid claims, officials announced on Wednesday.

Easter Jean Watson has been charged with theft, fraud and forgery and could spend the rest of the rest of her life in prison if convicted, Illinois Attorney General Attorney Kwame Raoul announced. Watson is charged with managed health care fraud, two counts of theft and forgery in connection with the alleged fraudulent activity.

Watson is a licensed clinical social worker and the owner of Loudek Community Services, according to a news release. Raoul said in a news release that she submitted claims for psychotherapy and counseling services that she did not provide to 10 Medicaid Managed Care patients.

Find out what’s happening in Beverly-MtGreenwoodwith free, real-time updates from Patch.

A message left at the health clinic seeking comment on the charges brought against Watson was not immediately returned to Patch on Wednesday.

According to the agency’s website, the organization provides a Behavioral Health Agency whose overall goal is to provide quality, comprehensive, holistic services to individuals across the lifespan. Loudek, the website said, is dedicated to improving the quality of life of those individuals we serve through psychotherapeutic counseling, advocacy, crisis intervention, family stabilization and substance abuse treatment.

Find out what’s happening in Beverly-MtGreenwoodwith free, real-time updates from Patch.

“Thousands of Illinois residents rely on Medicaid for their health care. It is unconscionable that a health care provider would defraud the people of Illinois by allegedly misusing needed Medicaid resources,” Raoul said. “I am committed to working with the Illinois State Police to identify Medicaid fraud and hold those who engage in it accountable.”

The case was investigated by the Illinois State Police Medicaid Fraud Control Unit, Raoul said.

“The Illinois State Police will continue to work closely with Attorney General Raoul’s office to ensure those who attempt to defraud government and the taxpayers will be brought to justice,” Illinois State Police Director Brendan Kelly said in a news release.

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MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: You paid $32k for a Medicaid transportation scam.

 
 

Clipped from: https://ncdoj.gov/attorney-general-josh-stein-announces-medicaid-fraud-pleading/

 
 

For Immediate Release:
Friday, December 9, 2022

Contact: Nazneen Ahmed
919-716-0060

(RALEIGH) Attorney General Josh Stein today announced that Terry Lee Sayre has pleaded guilty to the felony of obtaining property by false pretenses in Brunswick County Superior Court. Judge Jason C. Disbrow sentenced Sayre to 60 months of supervised probation. Sayre also was ordered to pay $ 31,882.50 in restitution to the North Carolina Medicaid Program.

“When people cheat the Medicaid program, they’re cheating North Carolina’s taxpayers,” said Attorney General Josh Stein. “My office will not allow it. I commend District Attorney Jon David and my team for their hard work and partnership on this case.”

Medicaid pays for transportation to medical appointments for eligible recipients who need assistance with transportation. Sayre and his co-defendant, Julie Ridgdill, submitted fraudulent transportation invoices and forms to the Brunswick County Department of Social Services (Brunswick DSS). As a result, Brunswick County paid the defendants $31,882.50 of Medicaid funds for transportation services that were not provided. Ridgdill previously pleaded guilty and was sentenced to 6-17 months in jail, which was suspended, and she was placed on supervised probation for 24 months and ordered to pay restitution.

This case originated from a referral from the Brunswick County Sheriff’s Office. This conviction was obtained in collaboration with District Attorney Jon David.

About the Medicaid Investigations Division (MID)

The Attorney General’s MID investigates fraud and abuse by health care companies and providers, as well as patient abuse and neglect in facilities that are funded by Medicaid. Medicaid is a joint federal-state program that helps provide medical care for people with limited income. To date, the MID has recovered more than $1 Billion in restitution and penalties for North Carolina.

MID receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $6,106,236 for Federal fiscal year (FY) 2022. The remaining 25 percent, totaling $2,035,412 for FY 2022, is funded by the State of North Carolina. To report Medicaid fraud in North Carolina, call the North Carolina Medicaid Investigations Division at 919-881-2320. 

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