Tag: Fraud

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]: Was the name of the company really not a red flag?

 
 

 
 

Clipped from: https://www.mobihealthnews.com/news/pill-club-reaches-183m-settlement-alleged-medicaid-fraud-california

 
 

Photo: krisanapong detraphiphat/Getty Images

Online birth control pharmacy The Pill Club reached an $18.3 million settlement with California authorities for allegedly defrauding the state’s Medicaid program.

According to the California Department of Justice, the company billed Medi-Cal for services it hadn’t provided, allegedly submitting claims for 30-minute face-to-face counseling sessions when its nurse practitioners didn’t have direct or real-time contact with patients. The California Department of Insurance said the birth control provider would bill for in-person visits when nurses were only reviewing patient questionnaires.

The state DOJ also claimed The Pill Club dispensed female condoms to beneficiaries who didn’t want or ask for the contraceptives, billing Medi-Cal significantly above the retail price.

The settlement calls for $15 million to be paid to the DOJ, while $3.3 million will go to the CDI. It comes days after a state court unsealed a whistleblower complaint against The Pill Club, where former nurse practitioners also alleged the company had defrauded private insurers in at least 38 states, including California.

According to a statement from their attorneys, the whistleblowers will receive nearly $5 million from the settlement. 

“The Pill Club unacceptably siphoned off Medi-Cal funding intended to help vulnerable communities access essential healthcare,” California Attorney General Rob Bonta said in a statement. “I am grateful to the whistleblowers and our investigators who were instrumental in holding The Pill Club accountable.

“At the California Department of Justice, we fight every day to protect and expand access to healthcare. We will not tolerate companies who attempt to unlawfully enrich themselves at Medi-Cal’s expense.”

A spokesperson for The Pill Club said it wasn’t required to be monitored or change any business practices as part of the settlement, and they noted it wasn’t settling in any other states. However, the company plans to improve its billing practices, update measures to ensure patients only receive medications and contraceptives they request, and implement new patient informed consent practices.

“When I joined The Pill Club just over two years ago, I was drawn to the challenge of strengthening our operations to live up to our mission. I’m glad to have the opportunity to resolve these issues and to bring our full focus back to expanding access to contraceptive care for all who need it,” Liz Meyerdirk, The Pill Club’s CEO, said in a statement.

THE LARGER TREND

The Pill Club, which launched in 2016, raised a $51 million Series B three years later and another $41.9 million in 2021.

The company briefly changed its name to Favor to highlight its non-contraceptive services, but it returned to its previous branding following a lawsuit from a restaurant and retail delivery company that also used the name.

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]: MA plans will have to pay back a lot of cash that they stole back when CMS let them get away with the rampant upcoding. The first year that CMS will enforce the paybacks will be 2018. Why that year? I wonder how much overpayments MA plans got the few years before that, and who was in charge at CMS those years, and did they have any specific connection to the overall RADV upcoding scandal? Probably just a bunch of dead end questions, I’m sure.

 
 

Clipped from: https://www.medpagetoday.com/reading-room/publichealthpolicy/medicare/102889

– Audits finding unsubstantiated claims will extrapolate overpayments to insurers’ other claims

With a more aggressive rule finalized Monday, the Centers for Medicare & Medicaid Services (CMS) said it expects to recover billions more in overpayments from Medicare Advantage plans that upcoded their enrolled beneficiaries as being sicker or requiring more intense levels of care than their medical records could support.

The agency’s revised risk adjustment data validation (RADV) tool will allow the agency to extrapolate the amounts of overpayments found in audited claims that must be repaid to much larger sets of claims submitted by the plan that year. It will “protect the fiscal sustainability” of Medicare, said Health and Human Services Secretary Xavier Becerra during a news conference.

The new extrapolation policy applies to plan years 2018 and later. CMS will not apply the policy to prior years, meaning Medicare Advantage plans will get to keep the money audits determined were wrongfully obtained.

Until now, the amount the plans were supposed to pay back was based just on those overpayments that audits found among the small sample of claims audited. But the new rule enables Medicare to extrapolate the amount owed from those audited claims to all claims submitted for patients in a diagnostic subgroup, thus putting companies on the hook to pay back a lot more money.

“Thanks to this final rule, CMS will now be able to provide appropriate oversight and ensure the integrity of the entire Medicare program by taking specific steps to collect payments made to Medicare Advantage plans to which they were never entitled under our laws and regulations,” Becerra said.

Dara Corrigan, director of the CMS Center for Program Integrity, estimated that in plan payment year 2018 alone, the agency expects to recover $479 million under the new rule. For the 10-year period of 2023 to 2032, it’s estimated the amount recovered will reach $4.7 billion.

The problem has evolved because Medicare Advantage organizations (MAOs) receive a lot more money from Medicare each month for patients with higher health risk scores, as sicker patients presumably will cost more money. But CMS audits have revealed enrollee health histories that do not substantiate their illness, along with patients never treated for their apparent conditions. “There is an incentive for MAOs to potentially over-code diagnoses to increase their payments, that is, to code diagnoses not properly substantiated by medical record documentation,” CMS said in its final rule.

Dozens of Office of Inspector General (OIG) investigations have found most of the largest Medicare Advantage plans have coded their enrollees with illnesses or conditions that the plan providers’ medical records could not support. In the last 2 years alone, OIG released results of investigations that found exaggerated upcoding worth $461 million, according to a MedPage Today search of the agency’s investigative findings.

The practice continues. In its final rule Monday, CMS said that in fiscal year 2021, based on 2019 payments, “we calculated that CMS made over $15 billion in Part C overpayments, a figure representing nearly 7 percent of total Part C payments.”

The agency had originally proposed beginning the extrapolation method for assessing overpayments that MAOs needed to pay back starting with the 2011 payment year.

Asked why the agency decided not to expand the new RADV rule to years before 2018, Corrigan said the agency had to consider all policy discussions and stakeholder input, and the integrity of the program.

The rule also explains that the 2018 year was selected as the starting point for the new policy because of the number of appeals expected from MAOs. “By not using an extrapolation methodology prior to [payment year] 2018, we expect to better control the total number of active appeals that are submitted in the first few years following finalization of this rule, which will alleviate burden on MAOs and CMS,” the rule explained.

Asked if MAOs will challenge the new rule with lawsuits, Becerra and Corrigan declined to comment. “We have a policy on not commenting on any future litigation,” said Corrigan.

In a press release accompanying the rollout of the final rule, CMS said that despite audit findings of overpayments to Medicare Advantage plans going back years, no risk adjustment overpayments have been collected since payment year 2007.

The rule explained that CMS will focus on overpayment subgroups identified by hierarchical condition categories (HCC), representing clinical diagnoses, that are at the highest risk for improper payments.

Better Medicare Alliance, a coalition of stakeholders including MAOs, said it is still reviewing the new rule. But the organization has concerns about “potential unintended consequence of creating an environment of higher premiums and fewer benefits for the more than 29 million seniors and people with disabilities who choose Medicare Advantage,” President and CEO Mary Beth Donahue, said in a statement. “We encourage CMS to work with stakeholders to put in place solutions that are transparent and fair to preserve stability for beneficiaries.”

The president and CEO of America’s Health Insurance Plans (AHIP), Matt Eyles, also was not happy. He called the rule “unlawful and fatally flawed, and it should have been withdrawn instead of finalized. The rule will hurt seniors, reduce health equity, and discriminate against those who need care the most.”

The problem of Medicare Advantage upcoding has increased over the years as MAOs have engaged in aggressive — and sometimes deceptive — marketing and television advertising campaigns that have enrolled millions of seniors. CMS is now trying to curtail such campaigns by employing secret shoppers and requiring that all calls with plan representatives be recorded.

By the end of this year, more than half of all Medicare beneficiaries will be enrolled in a Medicare Advantage plan, attracted by zero or low monthly premiums and the promise of other benefits like dental care, some prescription drug coverage, or gym memberships. However, the downsides of such plans are often poorly explained, and some beneficiaries find that when they need services — a trip to the doctor or a certain prescription — they may have to make unexpected and sometimes pricey co-payments.

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]: Another personal care services fraud got about $30k from your W2s.

 
 

Clipped from: https://www.wibw.com/2023/01/31/father-daughter-get-near-identical-sentences-medicaid-fraud-scheme/

 
 

FILE(MGN)

WICHITA, Kan. (WIBW) – A father-daughter pair from Wichita have both been sentenced to repay more than $14,000 and $16,000 as well as to serve a year of probation following a Medicaid fraud scheme.

Kansas Attorney General Kris Kobach says that a man from Wichita has been sentenced to repay more than $14,000 to the Kansas Medicaid system following a conviction on two fraud-related charges.

AG Kobach indicated that Johnson Kongvongsay pleaded guilty in December to one felony count of making a false claim, statement or representation to the Medicaid program and one misdemeanor count of unlawful acts concerning computers.

Court records show that Sedgwick Co. District Judge Tylor Roush on Jan. 26 sentenced Kongvongsay to 18 months in jail, however, the jail sentence was suspended and he was ordered to repay the Kansas Medicaid program a total of $14,857.78 and serve a year of supervised probation.

Kobach noted that an investigation found Kongvongsay and his daughter, Kyla, at different points in time had worked as personal care assistants for a relative who was a Medicare beneficiary. Investigators found the pair had submitted false claims and purported to provide personal care services when they were actually working other jobs.

Investigators also found that the pair had committed $30,947.45 worth of fraud.

Kobach indicated that Kyla, 22, also pleaded guilty in December to one felony count of making a false claim, statement or representation to the Medicaid program and one misdemeanor count of unlawful acts concerning computers. She was sentenced to repay $16,089.67 and 12 months of supervised probation.

 
 

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]: A device maker did a backdoor billing / kickback scheme with the help of some local DME providers.

 
 

Clipped from: https://www.justice.gov/usao-ednc/pr/illinois-medical-device-manufacturer-agrees-pay-500000-resolve-allegedly-fraudulent

RALEIGH, N.C. – United States Attorney Michael Easley announced today that Joint Active Systems, Inc. (JAS), a manufacturer of range-of-motion devices located in Effingham, Illinois, has agreed to pay $500,000 to settle civil claims under the Federal and North Carolina False Claims Acts concerning allegations that JAS caused submission of false claims to the North Carolina Medicaid program for certain durable medical equipment.

Specifically, the United States and the State of North Carolina alleged that from January 6, 2012 through January 29, 2021, JAS was unable to directly bill North Carolina Medicaid for its “EZ” range-of-motion devices because JAS did not meet North Carolina Medicaid requirements and/or lacked credentials necessary to do so.  JAS allegedly bypassed those requirements—and its concomitant inability to bill North Carolina Medicaid directly—by entering into arrangements with local North Carolina orthotics and prosthetics providers to bill EZ devices on its behalf.  JAS allegedly directed the local North Carolina orthotics and prosthetics providers to improperly submit claims for JAS EZ devices as orthotics using “L-Codes” under the Healthcare Common Procedure Coding System (“HCPCS”), thereby bypassing the medical necessity reviews and/or authorization processes that may have otherwise taken place.  The Governments alleged that the JAS EZ devices did not qualify for reimbursement as “L-Code” orthotics under North Carolina Medicaid, and that the JAS EZ devices were not listed as reimbursable devices on the North Carolina Medicaid fee schedule.  Indeed, JAS received an official coding verification from the Centers for Medicare and Medicaid Services that designated one of JAS’s EZ devices as an “E-Code” (durable medical equipment) device, not as an “L-Code” (orthotic) device.  The Governments alleged that JAS nevertheless continued to use local North Carolina providers to bill its EZ devices as “L-Code” devices.  In turn, JAS allegedly would pay the local orthotics and prosthetics providers by allowing them to retain a certain amount of the reimbursement.

“The Department of Justice is actively pursuing health care companies and medical device manufacturers who overcharge government healthcare programs,” said United States Attorney Michael Easley.  “We cannot allow companies to bypass rules and regulations to enrich themselves, while depleting taxpayer funds set aside for legitimate patient care.”

“My office’s Medicaid Investigations Division will hold accountable Medical device manufacturers who drain resources from our government healthcare programs, no matter how elaborate and layered the scheme may be,” said North Carolina Attorney General Josh Stein.

The Federal and North Carolina False Claims Acts authorize the Governments to recover triple the money falsely obtained, plus substantial civil penalties for each false claim submitted.  

It should be noted that the civil claims resolved by settlement here are allegations only, that there has been no judicial determination or admission of liability, and that JAS denies the allegations. 

This matter was investigated by the United States Attorney’s Office for the Eastern District of North Carolina and the Medicaid Investigations Division of the North Carolina Attorney General’s Office (“MID”).  Special Deputy Attorney General Matthew R. Petracca, who also serves as a Special Assistant United States Attorney, represented the United States and the State of North Carolina.

The United States Attorney’s Office for the Eastern District of North Carolina, in partnership with law enforcement agencies and state entities, investigates and prosecutes healthcare providers that defraud government programs, including Medicare and Medicaid, and abuse their patients.  The Medicaid Investigations Division investigates and prosecutes healthcare providers that defraud the Medicaid program, patient abuse of Medicaid recipients, patient abuse of any patient in facilities that receive Medicaid funding, and misappropriation of any patients’ private funds in nursing homes that receive Medicaid funding.  To report Medicare fraud or patient abuse in North Carolina, please visit the United States Department of Health and Human Services’ website at https://oig.hhs.gov/fraud/.  To report Medicaid fraud or patient abuse in North Carolina, please call the MID at 919-881-2320.

 
 

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]: Auditor finds millions in waste, again. State officials say “don’t worry we have it handled,” again.

 
 

Clipped from: https://cbs6albany.com/news/you-paid-for-it/ny-comptroller-audit-reveals-months-totaling-billions-in-improper-medicaid-payments-s-third-party-health-insurance-ny-doh-department-of-health-dinapoli

 
 

 
 

New York State Comptroller Thomas DiNapoli has released an audit of the Department of Health’s Medicaid claims processing program that he says identified more than $22 million in improper Medicaid payments from October of 2021 through March of 2022.

Among the findings from the comptroller, $11.5 million was paid for managed care premiums on behalf of Medicaid recipients who also had concurrent comprehensive third-party health insurance.

MORE: NYS Comptroller: Office of Children and Family Services needs to better-protect children

$8.9 million was paid for clinic, practitioner, inpatient, managed care and laboratory claims that did not comply with Medicaid policies, such as billing in excess of permitted limits.

In response, the Department of Health said the Office of the Medicaid Inspector General continuously performs audits of Medicaid payments, and the DOH says it will continue to work to recover overpayments as appropriate.

MORE: Governor signs bill to restore comptroller’s oversight powers for state contracts

As a result of the audit, about $9.9 million of the improper payments had been recovered by the end of the audit fieldwork.

During the six-month period in question, the DOH processed more than 294 million claims, resulting in payments to providers of nearly $42 billion.

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 gave Carol $31k for false personal care attendant claims. She did not say thank you.

 
 

Clipped from: https://www.wibw.com/2023/01/26/johnson-co-woman-ordered-pay-31k-restitution-medicaid-fraud/

 
 

A Johnson Co. woman has been sentenced for Medicaid fraud and has been ordered to pay $31,000 in restitution to the Kansas Medicaid program.(Office of the Attorney General)

JOHNSON CO., Kan. (WIBW) – A Johnson Co. woman has been sentenced for Medicaid fraud and has been ordered to pay $31,000 in restitution to the Kansas Medicaid program.

Kansas Attorney General Kris Kobach announced Wednesday that Carol Elaine Hensley, 63, of Overland Park, has pleaded guilty to one count of making a false claim, statement, or representation to the Medicaid program and one count of unlawful acts concerning computers in Johnson Co. District Court. The court judge sentenced Hensley to 24 months behind bars, but that sentence has been suspended; Hensley has now been ordered to serve one year of supervised probation and pay $31,174.49 in restitution.

According to Kobach’s office, investigators looking into Hensley’s case discovered that she served as a personal care attendant for her two adult children, who also happen to be Medicaid beneficiaries. As investigators looked further, they found that Hensley submitted claims for payment to the Medicaid program as if she were providing services to her adult children from January 1, 2018, to February 28, 2022. However, investigators said that Hensley was instead working at different jobs and signed up her adult children for in-day support services.

Kobach said that Hensley’s case is part of an ongoing, cooperative effort between the Kansas Attorney General’s office and the U.S. Department of Health and Human Services/Office of Inspector General called “Operation Keeping Them Honest.” The collaboration is focused on investigating fraudulent billing to the Medicaid program for personal care services in the homes of Medicaid beneficiaries.

Kobach’s office said that nine cases have, so far, been filed within the courts, and five cases have reached the sentencing phase.

The Attorney General’s office said that the other cases are ongoing, joint investigations conducted by the federal and state authorities and prosecuted by Kobach’s Medicaid Fraud and Abuse Division.

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]: Three brothers ran an absolutely massive dental empire, full of fraud. The thing that finally got em collared? Implanting unapproved medical devices they developed in the mouths of Medicaid patients. You paid them at least $4M in fraud just for the embezzling part.

 
 

 
 

Clipped from: https://www.inquirer.com/news/medicaid-fraud-dentists-bhaskar-savani-biranjan-savani-montco-pennsylvania-federal-indictment-20230125.html

Prosecutors say Bhaskar, Arun, and Niranjan Savani broke at least a dozen laws in their efforts to generate millions in profits between 2009 and last year.

 
 

Dreamstime / MCT

Federal authorities have accused the owners of a Montgomery County-based dental conglomerate of running their businesses like a criminal enterprise — bilking millions of dollars from government health-care programs, illegally importing foreign workers, and endangering patients by implanting unapproved medical devices in their mouths for profit.

Brothers Bhaskar Savani, 56, of Ambler; Arun Savani, 55, of Blue Bell; and Niranjan Savani, 51, of Ambler, broke at least a dozen laws in their efforts to generate more than $316 million in profits between 2009 and last year, prosecutors said in a sprawling 102-page indictment unsealed Tuesday.

Investigators also accused the siblings of laundering their illicit proceeds through hundreds of bank accounts and embezzling more than $4 million from nearly three dozen companies to cover personal expenses like a Hawaiian vacation home, college tuition for their children, and utilities and tax payments on their homes.

The charges against the Savanis and nine codefendants — which include counts of racketeering conspiracy, visa and health-care fraud, money laundering, and conspiracy to distribute misbranded medical devices — are the result of a years-long investigation by nearly a dozen state and federal agencies into the empire the Savanis oversaw from a nondescript office park in Fort Washington.

Attorneys for the brothers balked at the government’s accusations, calling them a distortion of the Savani brothers’ companies and careers that now threatens to send them to prison for up to 20 years on the most serious count they face.

“The three brothers look forward to their day in court and cherish the concept that in this country that they have made their home, people are presumed innocent,” the lawyers said in a statement.

Viewed through a certain lens, the business empire the Savanis created since their arrival in the United States is an unquestionable success.

After emigrating from India, Bhaskar Savani, known as “Dr. B,” earned his dental degree from Temple University in 1995 and quickly set about building his practice into an empire.

Aside from his dental practices, he became an evangelist for the importation of Indian mangoes, persuading the U.S. Department of Agriculture in 2007 to lift a 18-year ban, and expanded into real estate, becoming one of the financial backers of a proposed indoor velodrome in Valley Forge in 2006.

Meanwhile, he brought on brothers Arun, to oversee financial affairs for the businesses, and Niranjan, a fellow dentist, to help him expand his core dental businesses into an empire.

Today, they oversee more than 50 dental practices across states including Pennsylvania, New Jersey, Iowa, and South Carolina and a bevy of associated companies focused on research and development of dental implant devices, employ more than 400 people, and serve thousands of patients each year, many from inner cities and other underserved areas where there are few practicing dentists.

Prosecutors say serving those low-income clients — especially those enrolled in government-funded health-care programs like Medicaid — was central to the Savani brothers’ grift.

Among other crimes alleged in the indictment, the Savanis are accused of relying on uncredentialed dentists to treat patients in violation of Medicaid rules.

Savani businesses allegedly required those dentists to falsely state that other licensed dental providers employed by their companies had performed treatments billed to Medicaid and required them to pay kickbacks to the doctors whose names they were using.

For instance, prosecutors said, between 2014 and 2018 Savani businesses submitted roughly 2,600 claims falsely stating that Niranjan Savani was the dentist performing procedures, when he was not even in the country at the time they were performed.

When authorities would catch on to the scheme and cancel Medicaid contracts with one Savani company, they’d have an employee open another — running it in name only — to land those contracts again, according to the indictment.

Between 2013 and last year, just one of those businesses — Allentown-based Smilekrafters Dental — earned roughly $80 million in Medicaid reimbursements under a contract it had fraudulently obtained, the document states.

But prosecutors said even as the Savanis were taking advantage of weaknesses in the Medicaid oversight, their companies were also exploiting foreign-born employees who worked for them.

The brothers recruited workers from India and elsewhere for jobs in the United States through a program meant to hire employees with specialized skills such as scientists, programmers, researchers, and analysts.

However, investigators say, many of the people for whom they helped secure visas ostensibly for jobs in the Savanis’ research-oriented companies, ended up in nonspecialized jobs running dental offices or as administrators being paid less than prevailing wage and required to kick back portions of their salaries to others in the companies.

The indictment paints one of the businesses run by the Savanis — Fort Washington-based EZ Biotek — as a front, filled with nonfunctioning lab equipment meant to fool immigration authorities when they would show up for periodic visits to verify those employees were working in active dental or chemistry research labs.

Still, some of the Savani companies’ research efforts were legitimate — including those at Fort Washington-based Osseolink USA, which starting in 2017 began developing a new kind of synthetic tooth implant for use in patients.

Though the implants had not yet received approval from the Food and Drug Administration, the brothers’ companies shipped prototypes in bags marked “not for human use” to several dental offices, where dentists employed by the brothers used them in the mouths of at least 18 patients, prosecutors said.

“Health care providers, who have a duty to practice in their patients’ best interests, are especially deceitful when they commit Medicaid fraud,” said Maureen R. Dixon, head of the U.S. Department of Health and Human Services’ Office of Inspector General.

In addition to the criminal charges, prosecutors are seeking forfeiture of some 27 properties linked to the Savanis and their businesses in Philadelphia, Montgomery, Delaware, Bucks, and Lehigh Counties as well as Iowa and Hawaii.

The brothers were released on bail pending trial after a brief initial court appearance Tuesday.

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]: Bridges MN is under investigation for billing for home care services on properties that it owns. Current estimate is at least $4M in fraudulent billing.

 
 

 
 

Clipped from: https://kstp.com/kstp-news/top-news/in-home-care-provider-investigated-for-4m-in-medicaid-fraud/

A St. Paul-based home health care company is being investigated by the Minnesota Attorney General’s Office for fraudulently overbilling the state’s Medicaid program, which is designed to support low-income residents and people with disabilities.

State investigators took computers, financial reports, rental agreements, and other documents from Bridges MN on Thursday, according to court documents filed last week. Authorities say they have already tracked $4 million in fraudulent billing over five years, with the possibility of more instances of fraud expected, according to a search warrant.

Bridges provides in-home care to more than 40 individuals across Minnesota, according to the warrant. Since 2016, the company has been reimbursed over $146 million for services provided to Medicaid recipients.

The Minnesota Department of Human Services previously revoked Bridges MN’s license after finding instances of maltreatment and non-compliance. State records show that the company is appealing that decision and has continued to operate.

DHS pieced together possible fraud after reviewing years of financial documents, daily care notes, and interviews with whistleblowers. The investigation comes after years of warnings from the agency, which told Bridges MN executives in 2019 the company was at risk of billing fraud if it provided services outside of the federally approved waiver plans.

 
 

Minnesota Attorney General Keith Ellison speaks during a press conference regarding the proposed merger between Fairview and Sanford Health on Nov. 22, 2022. (KSTP-TV)

After two years of notices, “Bridges continued to bill for services… well after receiving the first notice of non-compliance,” investigators with the Attorney General’s Office said.

No one from Bridges MN has been charged with a crime.

In a statement to 5 INVESTIGATES, an attorney for Bridges MN said the company “denies any wrongdoing and believes that the allegations in the search warrant affidavit will prove to be incorrect,” adding: “While we proactively address these allegations, we will continue to focus our complete attention on the clients and caregivers who look to us for support.”

Company executives are also facing accusations of billing for services on properties they own or have a financial stake in, which is illegal for “own-home” services in Minnesota.

The state investigation found Bridges MN was billing for services even when some of its residents were sleeping, going to online school, or going to church.

A case worker told the company in a January 2021 email: “it is fraudulent billing, and I can’t make that any different,” according to the warrant.

Asked by investigators about the documented overbilling, co-owner, Chief Financial Officer and Vice President of Finance Scott Loe told DHS that his company “does not consistently review supporting documentation to determine how to bill.” Loe also told investigators it would be “a good question” for other staffers, the warrant states.

Bridges MN is in the process of being sold to another company, Caregiver, which state officials said they believe will provide the same types of services.