Tag: Fraud

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[MM Curator Summary]: Compassionate Counseling stole $150,000 of your tax dollars with bogus service claims.

 
 

Clipped from: https://ncdoj.gov/attorney-general-josh-stein-reaches-150000-medicaid-fraud-settlement-with-rockingham-health-care-provider/

 
 

For Immediate Release:
Wednesday, May 17, 2023

Contact: Nazneen Ahmed
919-716-0060

(RALEIGH) Attorney General Josh Stein today reached a $150,000 settlement with Compassionate Counseling Services in Rockingham to resolve allegations that the company submitted false claims to the North Carolina Medicaid program. The settlement funds will be returned to the program.

“Health care providers that receive Medicaid resources need to use those resources properly,” said Attorney General Josh Stein. “When providers fail to responsibly steward taxpayer dollars, my office will hold them accountable. I’m grateful to the U.S. Attorney Hairston and her office for their continued partnership to protect health care resources.”

From June 7, 2016, to Jan. 8, 2021, Compassionate allegedly billed Medicaid for diagnostic assessments that were backdated or not properly signed and dated by the required professional. Because of the lack of proper documentation, Compassionate failed to support that the assessments were properly rendered or that the services were necessary.

The civil claims resolved by settlement here are allegations only, there has been no judicial determination or admission of liability, and Compassionate denies the allegations.

The investigation and prosecution of this case was conducted by the United States Attorney’s Office for the Middle District of North Carolina and the Medicaid Investigations Division of the North Carolina Attorney General’s Office.

About the Medicaid Investigations Division (MID)

The Attorney General’s MID investigates and prosecutes health care 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 date, the MID has recovered more than $1 billion in restitution and penalties for North Carolina. To report Medicaid fraud or patient abuse in North Carolina, call the MID at 919-881-2320. The 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.

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[MM Curator Summary]: Amber Turner stole about $200,000 of your tax dollars. She did not say thank you.

 
 

Clipped from: https://www.amnews.com/2023/05/22/boyle-county-woman-pleads-guilty-to-medicaid-fraud/

Published 7:26 pm Monday, May 22, 2023

By Special to The Advocate-Messenger

 
 

NEWS RELEASE

An investigation and prosecution by the Kentucky Attorney General’s Medicaid Fraud Unit led to a guilty plea of a Boyle County woman for defrauding the Kentucky Medical Assistance Program, also known as Medicaid.

Attorney General Daniel Cameron announced Monday that Amber Turner, 36, of Danville, appeared at Boyle County Circuit Court last week, and entered a guilty plea to the charge of devising or engaging in a scheme to defraud the Kentucky Medical Assistance program of $300 or more, a Class D Felony. She will be placed on a five-year period of pretrial diversion, but still faces up to a five-year prison sentence if she does not successfully complete the period of diversion.

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As part of the plea agreement, Turner was also ordered to pay restitution to the Kentucky Medical Assistance Program in the amount of $200,000.

The Attorney General’s Medicaid Fraud Unit investigated the case. David R. Startsman, an attorney with the Medicaid Fraud Unit, prosecuted the case on behalf of the Commonwealth. If you wish to file a Medicaid fraud or abuse complaint, go to ag.ky.gov/MedicaidFraud or call the Medicaid Fraud and Abuse Hotline at 1-877-ABUSE-TIP, or 1-877-228-7384.

The Kentucky Attorney General’s Office of Medicaid Fraud and Abuse Control receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award of $6,333,333 for Federal fiscal year 2023. The remaining 25%, totaling $1,583,333 for FY 2023, is funded by the state.

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[MM Curator Summary]: Latissa, Shaqunna and Syretta worked together to use a child as a billing number to steal your tax dollars.

 
 

Clipped from: https://www.actionnews5.com/2023/05/19/3-memphis-women-indicted-tenncare-fraud-scheme/

 
 

(Left to right) Latissa Johnson, Shaqunna Jackson, and Syretta Jenkins(TBI)

MEMPHIS, Tenn. (WMC) – An investigation by special agents with the Tennessee Bureau of Investigation (TBI) Medicaid Fraud Control Division has resulted in the indictment and arrest of three women from Memphis.

In December 2022, TBI received a tip from BlueCare, a TennCare-managed care contractor, alleging fraudulent billing for TennCare services in Memphis. 

During the investigation, agents developed information that between June 2022 to October 2022, 37-year-old Latissa Johnson, who is the mother of a TennCare recipient, schemed with her child’s home care provider, 27-year-old Shaqunna Jackson, to submit claims for care that were never provided. 

Agents also determined Jackson’s supervisor, 42-year-old Syretta Jenkins, participated in the scheme.

On May 2, a Shelby County Grand Jury returned indictments charging Johnson, Jackson, and Jenkins each with TennCare fraud and theft of property ($10,000 to $60,000). 

On Tuesday, Jackson and Jenkins surrendered to authorities. 

Friday, with the assistance of the Memphis Police Department Fugitive Team, Johnson was taken into custody. 

All three were booked into the Shelby County East Women’s Facility on a $25,000 bond.

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[MM Curator Summary]: Marion Lund stole $1.4M of your tax dollars. He did not say thank you.

 
 

Clipped from: https://www.picayuneitem.com/2023/05/mississippi-man-sentenced-for-1-4-million-in-fraudulent-medical-charges/

Published 4:07 pm Friday, May 19, 2023

By Special to the Item

 
 

A Panola County man was sentenced Monday to two years in prison following his conviction for his role in a scheme to defraud Medicare and TRICARE by prescribing and dispensing medically unnecessary foot bath medications and ordering medically unnecessary testing of toenails in exchange for kickbacks and bribes. According to court documents, Marion Shaun Lund, D.P.M., 54, of Batesville, owned and operated a podiatry clinic, as well as an in-house pharmacy in Oxford. Lund routinely wrote prescriptions for and dispensed antibiotic and antifungal drugs to be mixed into a tub of warm water for patients to soak their feet. Rather than prescribing drugs based on the individualized needs of patients, Lund prescribed foot bath medications in order to maximize reimbursements from Medicare, TRICARE and other health care benefit programs, regardless of medical necessity.

In addition, Lund took toenail clippings and wound cultures from patients and sent them to a lab for diagnostic testing, even though such testing was not medically necessary. From April 2020 through March 2022, Lund caused the submission of over $1.4 million in claims to Medicare and TRICARE for unnecessary prescriptions of foot bath medications and diagnostic testing of toenails, resulting in over $700,000 in reimbursements. In exchange for his prescriptions and orders, Lund was paid cash kickbacks by a purported marketer. On Feb. 2 Lund entered a plea of guilty to one count of conspiracy to commit health care fraud. On Monday morning, U.S. District Judge Glen Davidson sentenced Lund to 24 months in prison, followed by three years of supervised release and ordered Lund to pay restitution in the amount of $851,428.  Lund is the fourth defendant, including three medical professionals, to plead guilty and be sentenced for a role in the scheme. In October 2021, Logan Hunter Power pleaded guilty to one count of conspiracy to defraud the United States and to pay and receive kickbacks, and in October 2022, Power was sentenced to 25 months in prison. In August 2022, Jared Lee Spicer, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve a term of three years probation. In September 2022, Carey “Craig” Williams, D.P.M., pleaded guilty to one count of conspiracy to commit health care fraud and was sentenced to serve 42 months in prison. Trial Attorney Sara E. Porter and Assistant Chief Justin M. Woodard of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Clayton A. Dabbs of the Northern District of Mississippi prosecuted the case.

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The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, composed of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes.

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[MM Curator Summary]: This was always going to happen.

 
 

https://www.lohud.com/story/news/2023/05/15/medicaid-renewal-phone-scam-targeting-new-yorkers-what-to-know/70212823007/

 
 

David Robinson

New York State Team

0:30

2:02

Authorities warned Friday of a new telephone scam targeting New Yorkers enrolled in Medicaid and other related government health plans.

The scammers are deceptively calling people and asking them to pay hundreds of dollars to maintain their health insurance through Medicaid and related programs, said Attorney General Letitia James and Acting Health Commissioner Dr. James McDonald.

The truth is that there is no charge or fee to renew your health insurance in Medicaid, Child Health Plus, or the Essential Plan. 

 
 

The scheme aims to capitalize on the monumental state and federal effort underway to renew Medicaid or related coverage for millions of New Yorkers after pandemic-era measures expired. The renewal process paused during the pandemic but recently restarted. The renewal reviews will continue through spring 2024.

 
 

From <https://www.lohud.com/story/news/2023/05/15/medicaid-renewal-phone-scam-targeting-new-yorkers-what-to-know/70212823007/>

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[MM Curator Summary]: A developing (and concerning) story out West.

 
 

 
 

Clipped from: https://azgovernor.gov/office-arizona-governor/news/2023/05/governor-hobbs-announces-actions-against-fraudulent-medicaid

PHOENIX— Today, Governor Hobbs, alongside Attorney General Mayes, Salt River Pima-Maricopa Indian Community President Martin Harvier, AHCCCS Director Carmen Heredia, representatives from 13 tribal nations, and law enforcement, announced actions against over 100 Medicaid behavioral health residential and outpatient treatment service providers believed to be engaging in fraud. These providers have taken advantage of vulnerable individuals, particularly in tribal communities, and profited off their pain and suffering rather than providing real care. 

“Prior to my administration, AHCCCS had taken a piecemeal approach to targeting these fraudulent providers,” said Governor Katie Hobbs. “Under my administration this will change. Thank you to our law enforcement officials and AHCCCS for taking action, and to our MMIP Task Force for helping bring to light these fraudulent providers and the stories of those who have been affected by them. Together, we are going to bring about the systemic reforms we need to root out this problem and deliver true accountability.”

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[MM Curator Summary]: Mr. Osemwengie stole $17.7M of your tax dollars. He did not say thank you.

 
 

 
 

Clipped from: https://www.texasattorneygeneral.gov/news/releases/paxtons-medicaid-fraud-control-unit-helps-secure-swift-conviction-healthcare-marketer-illegal

Attorney General Paxton’s Medicaid Fraud Control Unit successfully secured a conviction against Patrick Osemwengie, of Richmond, Texas, in a Houston federal court. Osemwengie played a supporting role as part of a larger home health conspiracy that resulted in $17.7 million in fraudulent Medicare and Medicaid billings. 

“The outstanding efforts of our dedicated Medicaid Fraud team have once again ensured that those who exploit our healthcare system for personal gain are brought to justice,” said Attorney General Paxton. “My office is committed to aggressively pursuing those who engage in healthcare fraud, safeguarding taxpayer funds, and preserving the integrity of vital healthcare programs.” 

Osemwengie illegally sold patient referrals to Grace Healthcare and Ebra Home Health Services, whose owners pleaded guilty to charges stemming from this investigation. Osemwengie charged $500 for new patients and $250 for recertifications. The home health providers then billed Medicare and Medicaid for home health services that were never provided. Several recipients have confirmed that Osemwengie paid them kickbacks to sign up for home health services. Other recipients were prevented from receiving genuinely needed home health services because of the scheme. 

A federal jury deliberated for 15 minutes following a two-day trial before finding Osemwengie guilty of conspiracy to pay and receive health care kickbacks.

The investigation was conducted by Sergeant Joyce Combest, Investigative Auditor Shen Wang, and Captain Rick McCollum of Paxton’s Medicaid Fraud Control Unit, in cooperation with the Department of Health and Human Services’ Office of Inspector General and the FBI. Assistant Attorney General Abdul Farukhi, who also serves as a Special Assistant U.S. Attorney, prosecuted the case along with Assistant U.S. Attorneys Christian Latham, James Hu, and Justin Martin. 

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[MM Curator Summary]: Ms. Bourret stole $1.1M of your tax dollars. She did not say thank you.

 
 

 
 

Clipped from: https://abcnews.go.com/Health/south-carolina-autism-clinic-director-indicted-federal-jury/story?id=99388124

Stamatina Bourret, 41, was indicted on 21 counts of health care fraud.

 
 

A South Carolina woman who ran an autism clinic is facing federal charges of health care fraud, according to the U.S. Attorney’s Office for the District of South Carolina.

Stamatina “Nina” Bourret, 41, from Greenville — 200 miles northwest of Charleston — was indicted by a federal grand jury Tuesday on 21 charges including fraud, and aiding and abetting for defrauding Medicaid.

According to the indictment, viewed by ABC News, Bourret ran Agapi Behavior Consultants, which allegedly provides clinic, in-school and at-home services for children with autism and other related disorders.

MORE: New York nursing home sued for fraud, neglect by state attorney general

The clinic’s website says its programs are for those between ages 18 months to 21 years, and treatment consists of behavioral support, emotional training, family training, social skill training and generalizing skills.

The indictment states that from about July 2020 to April 2022, Bourret billed Medicaid for services that she and other workers either only provided partially or did not provide at all.

 
 

Agapi Behavior Consultants location in Greenville, S.C., in a 2016 Google Street View image, now closed.

Google Maps Street View 2016

For example, the indictment alleges that Bourret submitted claims that services were provided on the weekends, despite the fact that Agapi was closed on weekends, and that she also submitted “false and fictitious claims for services beyond what was actually performed on the beneficiaries.”

She also submitted claims using the provider numbers of employees who did not work in the area of South Carolina where patients lived, and claims of employees who never treated these patients, the indictment says.

The claims ranged from about $58 to $436, according to the indictment.

The U.S. Attorney’s Office for the District of South Carolina did not immediately reply to ABC News’ request for comment.

Bourret was arrested Tuesday and was released on a $25,000 bond on the condition she surrender her passport.

MORE: New York midwifery charged with distributing fake COVID-19 vaccination cards

She faces a maximum of up to 10 years in prison for each charge. Bourret is also required to forfeit all process “obtained, directly or indirectly, from the offenses charged in this Indictment, that is, a minimum of approximately $1,109,430.00.”

Attempts to reach Bourret were unsuccessful, and a number listed for Agapi was not in service. Her next court appearance is scheduled for May 26 at the federal court in Greenville.

Her attorney, Andrew Moorman, told ABC News he could not comment on the case.

 
 

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[MM Curator Summary]: Husband and wife psychiatrists sole $658k of your tax dollars with a Medicaid scam. They did not say thank you.

 
 

 
 

Clipped from: https://www.justice.gov/usao-ct/pr/connecticut-psychologist-pays-658k-settle-allegations-she-received-payments-medicare-and

Vanessa Roberts Avery, United States Attorney for the District of Connecticut, and William Tong, Connecticut Attorney General, today announced that Dr. EVELYN LLEWELLYN has entered into a civil settlement agreement with the federal and state governments in which she will pay $658,294 to settle allegations that she received payments from the Medicare and Medicaid programs for psychology services that were not provided.

Llewellyn is a psychologist licensed by the State of Connecticut.  She is married to Dr. Michael Lonski, PhD, who is also a psychologist licensed by the State of Connecticut.  Llewellyn and Lonski maintained separate medical practices in psychology operated out of their home offices in Greenwich.  Lonski was responsible for submitting claims for reimbursement to insurance programs, including Medicare and Medicaid, for the psychology services allegedly performed by Lewellyn and Lonski.

The government alleges that Llewellyn received payment for claims submitted by Lonski to the Medicare and Medicaid programs for psychology services allegedly provided by Llewellyn to Medicare and Medicaid beneficiaries that were, in fact, not provided.

To resolve the governments’ allegations, Llewellyn has agreed to pay $658,294, which covers the time-period from November 11, 2014, through and including February 5, 2020.

On December 12, 2022, Lonski pleaded guilty in Hartford federal court to health care fraud.  He is scheduled to be sentenced on June 12.

This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation.  The case is being prosecuted by Assistant U.S. Attorneys Richard M. Molot and Susan L. Wines, and by Assistant Attorney General Joshua Jackson of the Connecticut Office of the Attorney General.

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

 
 

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[MM Curator Summary]: Ebony Mayo stole a Medicaid member ID to not have to pay for her own costs of care with her commercial insurance copays. You paid $16k for her to be able to do that.

 
 

Clipped from: https://patch.com/connecticut/hartford/hartford-woman-charged-stealing-medicaid-benefits-state

Crime & Safety

Connecticut’s chief state’s attorney charges the 42-year-old with using someone else’s identity to get Medicaid coverage.

 
 

Posted Fri, May 5, 2023 at 9:28 am ET|Updated Fri, May 5, 2023 at 9:30 am ET

 
 

State authorities have charged a Hartford woman with illegally obtaining Medicaid benefits for medical services so as to avoid co-pays with her regular medical insurance provider. (Shutterstock)

HARTFORD, CT — A Hartford woman has been charged this week with illegally obtaining Medicaid benefits when she wasn’t eligible.

Ebony Mayo, 42, of Hartford, was charged Wednesday with improperly using the identity of a Medicaid recipient and using that recipient’s identification to get medical goods and services for herself.

She was charged by inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney.

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

Mayo was charged with one count each of first-degree larceny by defrauding a public community, health insurance fraud and first-degree identity theft.

According to the arrest warrant affidavit, from March 2021 through October 2021, Mayo utilized the Medicaid number and personal identification of another party to acquire medical treatment and services for herself.

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

State officials said Mayo admitted to using the identity and Medicaid card of another to pay for her own medical visits and medications, even though she had her own insurance, in order to avoid co-payments.

The investigation revealed that by Mayo causing the fraudulent claims, Medicaid paid 93 claims for service amounting to a loss of $15,778, according to authorities.

Mayo was released on a $20,000 non-surety bond and is scheduled to appear in Hartford Superior Court May 16.

Each of the charges, according to state officials, are class B felonies punishable by up to 20 years in prison.

Anyone with knowledge of suspected fraud and abuse in the public health care system is asked to contact the Medicaid Fraud Control Unit at the Chief State’s Attorney’s Office at 860-258-5838.

For the full announcement of the charges, click on this link.

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