Tag: State News

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SD- South Dakota votes to expand Medicaid

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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]: SD got expansion approved by voters 56% to 44%, but it may be the last state to push expansion through the ballot box.

 
 

Clipped from: https://www.politico.com/news/2022/11/09/south-dakota-expand-medicaid-health-care-coverage-midterms-00065911

The Republican-controlled state, where lawmakers have long resisted Medicaid expansion, is the seventh in the last five years to do so at the ballot box — and likely the last to do so for some time.

 
 

“We are thrilled by this victory, which took years of work, coalition building, and organizing to achieve,” said Kelly Hall, executive director of the Fairness Project, which helped pass the ballot measure. “Citizens took matters into their own hands to pass Medicaid expansion via ballot measure — showing us once again that if politicians won’t do their job, their constituents will step up and do it for them.”

Opponents of Medicaid expansion tried to make passage of the ballot measure more difficult through a June initiative, Amendment C, that would have raised the voter approval threshold to 60 percent. That measure was overwhelmingly defeated.

Under the American Rescue Plan, the federal government encouraged states to expand Medicaid by covering an extra 5 percent of the costs of the program, in addition to the 90 percent it covers for newly eligible individuals under Obamacare.

The Kaiser Family Foundation estimates those incentives will send $110 million to South Dakota.

Opponents of Medicaid expansion, including Republican Gov. Kristi Noem, argued the measure would cost the state in the long run, force lawmakers to raise taxes, and discourage able-bodied adults from getting jobs. Proponents, meanwhile, pointed to the program’s success in the 38 other states that have implemented it over the last decade.

More than 17 million low-income Americans have gained coverage as a result of Medicaid expansion, a portion of the Affordable Care Act that was made optional as a result of a 2012 Supreme Court decision.

The South Dakota vote signals the end of an era for expanding Medicaid ballot box. Of the 11 states that still have yet to expand Medicaid, only three — Florida, Mississippi and Wyoming — have a voter-initiated ballot measure process, and none appear likely to take up the proposal in the short term.

In Florida, a 60 percent voter approval threshold makes passing ballot measures challenging. In Mississippi, the state Supreme Court effectively threw out the state’s ballot initiative process. And in Wyoming, proponents are pushing to expand Medicaid through the legislative process rather than at the ballot box.

Supporters of the measure included the South Dakota State Medical Association, the Greater Sioux Falls Chamber of Commerce and the South Dakota Farmers Union.
 

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PHE/ AR- How Arkansas is boosting Medicaid outreach ahead of PHE expiration

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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]: Groups can apply for $500 and $5,000 grants to help explain the wind-down process to members in their communities.

 
 

 
 

Clipped from: https://www.beckerspayer.com/payer/how-arkansas-is-boosting-medicaid-outreach-ahead-of-phe-expiration.html

The Arkansas Department of Human Services has launched a grant program for community-based organizations to assist the state’s Medicaid beneficiary outreach efforts ahead of the eventual end of the COVID-19 public health emergency. 

The public health emergency runs through at least Jan. 11. When the emergency ends, Arkansas Medicaid will redetermine eligibility for beneficiaries whose eligibility was extended solely due to the emergency, according to a Nov. 8 department news release. Arkansas Medicaid will also begin closing cases for ineligible individuals and for individuals who do not respond to requests to renew or provide information. 

Ahead of that ending, the department is seeking community-based organizations to help with outreach and engagement of their local constituencies, according to the release. The organizations will also help with the renewal process in some circumstances. 

Organizations with a proven track record for serving low-income children and adults, those with low incomes in rural communities, and low-income pregnant or postpartum women will be given priority for grants, according to the release.

 
 

What: Mini-grant program to assist the Arkansas Department of Human Services with important outreach and engagement efforts in advance of the eventual unwinding and ultimate end of the ongoing Public Health Emergency (PHE) related to the COVID-19 pandemic.

More Details: When the PHE ends, Arkansas Medicaid will redetermine eligibility for all Arkansas Medicaid clients whose eligibility has been extended solely due to the PHE. Arkansas Medicaid will also begin closing cases for ineligible individuals and for individuals who do not respond to requests to renew or provide information. 

DHS is seeking to partner with community-based organizations (CBOs) to assist with outreach and engagement of their local constituencies and, in some cases, helping with the renewal application process. DHS, with support from the Arkansas Foundation for Medical Care (AFMC), will identify eligible Arkansas 501c3 nonprofits for recruitment. These CBOs will then be asked to complete the application process and confirm they meet eligibility criteria for the grant opportunity. The goal is to serve all 75 counties. Applications will be reviewed in the order received and priority will be given to organizations which have a proven track record for serving low-income children and adults, those which serve low-income Arkansans in rural communities, and those which serve low-income pregnant or post-partum women. Partnerships in larger counties will be limited to at least one CBO Basic Outreach Partner per 75,000 residents and one CBO Enhanced Outreach Partner per 75,000 residents.  

Eligible CBOs will be required to complete a mini-grant application created by DHS. DHS may limit the number of CBOs who can participate in each county based on the county’s population and the number of partners already approved in the county. CBOs will identify their participation level as either a Basic Outreach Partner or an Enhanced Outreach Partner.

Basic Outreach Partners may be eligible for a one-time $500 stipend and Enhanced Outreach Partners may be eligible for a one-time $5,000 stipend for participation.

Program details and the application can be found at www.afmc.org/cbo. Please submit applications with required documents to cboinfo@afmc.org by December 16, 2022, at 5 p.m. Applications submitted after this date or are incomplete will not be considered for the first round of grant funding. 

 
 

From <https://humanservices.arkansas.gov/news/dhs-launches-mini-grant-program-to-assist-with-outreach-to-medicaid-clients-ahead-of-public-health-emergency-ending/>

 
 

 
 

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Missouri Medicaid application wait times down

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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]: For the first time since June the wait time is within federal requirements.

 
 

 
 

Clipped from: https://www.newstribune.com/news/2022/nov/01/missouri-medicaid-application-wait-times-down/

 
 

Average wait times for Missouri Medicaid applicants fell in September below the federally-allowed maximum for the first time in nearly a year.

According to Missouri’s Department of Social Services’ most recent publicly-available data, the state took 41 days on average to process a Medicaid application in September for the eligibility group which includes low-income children, pregnant people, families and adults.

Federal rules require these applications be processed within 45 days, and many states process them within a week.

The 41-day average wait time is down from its peak at 115 days in June.

Missouri’s average processing time exceeded the federal limit from December 2021 to August of this year, spurring federal involvement. The state attributed the long waits to staffing shortages and the challenges of implementing voter-approved Medicaid expansion.

DSS leadership told lawmakers last month the state had reached compliance with the federal timeliness rule. A spokesperson for the Centers for Medicare and Medicaid Services (CMS) said the agency cannot yet confirm Missouri has come into compliance because it is still reviewing the number of applications pending at 45 days or more.

From February to April, around four in five Medicaid applications in Missouri took longer than 45 days to process, according to a federal report. Missouri and Arkansas stood out in that report as the worst in the nation in timely processing of Medicaid applications.

Unlike the federal government, Missouri does not publish distributional data on the number of applications processed in more than 45 days — only averages.

For applicants, long wait times meant delaying needed care and foregoing purchasing necessary prescriptions, advocates said. The wait times also put the state on CMS’s radar.

In early 2022, CMS began working with the state to identify strategies to reduce processing times and high backlogs. CMS formally requested the state produce a mitigation plan in May, after identifying “multiple issues related to Missouri’s timely processing of applications.”

The mitigation plan went into effect in July and set the deadline of Sept. 30 for the state to come within the federal guidelines.

Designed to help the state process applications more quickly, the mitigation plan includes temporary measures such as enrolling parents based on children’s verified eligibility, allowing the agency to use verified income from applicants already enrolled in federal food benefits, and allowing the agency to accept verification from the federal marketplace. Advocates had long been pushing for the state to apply for these federal flexibilities.

Kim Evans, director of Family Support Division, last month credited increased flexibility through the mitigation plan and the work of department staff, who were offered overtime to help overcome the backlog. Evans has previously explained DSS moves staff around based on need.

“The same staff that process Medicaid also process SNAP,” Evans told the MO HealthNet Oversight Committee at a meeting in August, referring to the federal food benefit program.

The mitigation plan’s measures will remain in place until the end of the federal public health emergency. CMS granted the state’s request last week to extend the one waiver otherwise set to expire at the end of this year, which uses federal marketplace determinations to temporarily determine Medicaid eligibility.

The Family Support Division will continue to offer overtime during open enrollment season for the federal marketplace, which begins Nov. 1, said DSS spokesperson Caitlin Whaley, and “as needed” throughout the unwind of the public health emergency.

The Missouri Independent, www.missouriindependent.com, is a nonprofit, nonpartisan news organization covering state government and its impact on Missourians.

 
 

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Arkansas Advocate : CMS OKs Arkansas’ experimental Life360 program for vulnerable Medicaid groups

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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 new 1115 will launch 3 different programs to provide enhanced support services for pregnant mothers, members with SUD and foster kids.

 
 

 
 

Clipped from: http://www.magnoliareporter.com/news_and_business/regional_news/article_8f732624-5a78-11ed-b942-cbb0702f793f.html

 
 

Arkansas Gov. Asa Hutchinson speaks during a Nov. 1 news conference at the Arkansas State Capitol alongside state Rep. Jack Ladyman (R-Jonesboro).

Screenshot of livestream

The Biden administration on Tuesday approved a new component of Arkansas’ Medicaid expansion program focused on high-risk pregnancies, rural mental health care and at-risk young adults.

Life360 Homes was one of the final outstanding portions of Arkansas’ Medicaid expansion waiver that the Centers for Medicare and Medicaid Services hadn’t approved.

CMS signed off on most of the state’s new version of Medicaid expansion — ARHOME — in December. The federal agency still hasn’t given final approval to a component focused on increasing in-patient behavioral health access.

 
 

The Life360 concept aims to provide intensive, community-based care to three groups of people in Arkansas’ Medicaid expansion population:

People with high-risk pregnancies.

Rural residents with mental illness or substance-abuse disorders.

Young adults at risk for long-term poverty, like former foster children or formerly incarcerated.

At a Tuesday morning news conference announcing CMS’ approval, Gov. Asa Hutchinson said the new program would focus primarily on rural areas of the state.

“We know that it will make a great difference for very vulnerable populations in Arkansas,” the Republican governor said. “The reason it is so important is because Arkansas’ maternal mortality rate is one of the highest in the nation. Our infant mortality rate is one of the highest in the nation.

“We’ve got to tackle these difficult problems that we’ve had for decades and decades and decades.”

MEDICAID EXPANSION

Arkansas created a unique program following the 2010 passage of the Affordable Care Act, commonly known as Obamacare.

The federal health law allowed states to expand Medicaid to cover individuals whose incomes exceed the federal poverty level.

For that population, Arkansas created a program that uses Medicaid dollars to purchase private health insurance for eligible non-disabled adults between the ages of 19-64 with incomes up to 138% of the federal poverty level ($18,754 for an individual and $38,295 for a family of four).

The program has gone through various iterations, including the private option, Arkansas Works and ARHOME.

Arkansas is one of 39 states to expand Medicaid, but it is the only one using this experimental approach to incorporate the commercial health insurance market, making comparisons hard.

The program will cost north of $16 million, and as with the rest of Medicaid expansion, the state will shoulder 20% of the cost (about $3.2 million) and the federal government will cover 80%, or about $13.6 million.

ARHOME and its Life360 components are Section 1115 demonstrations. This is a part of Medicaid that allows states some flexibility to experiment with unique programs.

 
 

MATERNITY CARE

For high-risk pregnancies, birthing hospitals will contract with providers who conduct home visits to provide services for up to two years after birth.

The program’s outlined goal is to improve health outcomes for these infants and reduce the number of deliveries requiring Neonatal Intensive Care Unit services.

About 12,500 women on Medicaid had high-risk pregnancies in 2021, according to state data. The Life360 Homes will target women in the ARHOME program, but it will also be available to those on other Medicaid programs who are not already receiving similar services.

MENTAL HEALTH AND SUBSTANCE ABUSE

Under this component of the program, rural hospitals will provide clients with “intensive care coordination” for up to 24 months.

The hospitals will also provide community screens for social needs and receive money to operate “acute crisis units.”

About 52,000 ARHOME enrollees were diagnosed with serious mental illness or substance abuse disorders in 2021, according to state data.

VULNERABLE YOUTH

To help at-risk youth, hospitals in the Life360 program can partner with community organizations to build “life skills” to help vulnerable young adults avoid long-term poverty.

The community organization can help clients find safe housing, access education, apply for jobs and obtain driver’s licenses.

These services can last for two years.

Those served must have been in foster care or incarcerated. There are about 5,700 Medicaid expansion beneficiaries in Arkansas who were foster children at one time, data show.

The Arkansas Department of Human Services is ready to begin accepting letters of intent from those wishing to participate in the program.

There will be a public comment period (which closes Monday), application window and readiness review before clients can begin enrolling for services.

State Rep. Jack Ladyman (R-Jonesboro), chairman of the House Public Health Committee, said he believed the Life360 program would be a “game-changer.”

“We have to fix our worst problems, and we feel like these are the worst problems,” Ladyman said.

CLICK HERE to see more news at Arkansas Advocate, an affiliate of States Newsroom.

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Borrego Health Files for Chapter 11 Bankruptcy Protection; an Analysis

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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 largest FQHC in the nation has been found to be participating in massive, egregious fraud.

 
 

 
 

Clipped from: https://www.dentistrytoday.com/fqhc-borrego-health-files-for-chapter-11-bankruptcy-protection-an-analysis/

 
 

 
 

Borrego Community Health Foundation (Borrego Health) filed for chapter 11 bankruptcy protection on September 12, 2022, in the US Southern District of California (case no. 22-02384). Borrego Health claims assets of approximately $50-100 million, and liabilities of approximately $50-100 million. Formerly, Borrego Health was asserted to be the largest federally qualified health care (FQHC) non-profit organization operating in the nation.

 
 

PENpics Studio/shutterstock.com

Most of its production income allegedly originated from various schemes of abuses and fraud related to dental encounter fee agreements, by subcontracted private dentists.

Unlike typical subcontracted dental care from FQHCs, these uniquely constructed agreements by Borrego Health paid private dental providers on an encounter fee basis, and not via a fee-for-service methodology. As such, without intensive oversight by Borrego Health’s chief dental officer, Dr. Timothy S. Martinez, and his subordinate staff, fraud and abuses were seemingly encouraged. The FBI raided Borrego Health and its retained billing contractor, Premier Healthcare Management, on October 20, 2020.

One of the alleged more egregious contracted dental providers was Dr. Husam Aldairi and 40/30 Dental, which the new administration of Borrego Health has sued in a civil legal action and disputed him as a creditor. His extensive disciplinary actions from regulatory boards and failures to comply with consent agreements before the Illinois Dental Board and Illinois Department of Financial and Professional Regulation were public record, prior, and during his contracted time with Borrego Health. Also problematic were disturbing misrepresentations by Aldairi and a discipline ruling, and judicial fine handed down against Aldairi, in his Illinois bankruptcy.

All this troubling public record data related to Aldairi was easily accessible to the Dental Board of California (DBC), which credentials and renews dental licenses. It was also available to the California Department of Health Care Services (DHCS) which approves and renews credentialing for Medicaid providers. It was also easily obtainable through a due diligence vetting process under Borrego Health’s former chief dental officer, Martinez.

In fact, Martinez, under oath and under questioning by his attorney, stated, “I have done clinical work, but also part of my specialty is Medicaid fraud. So, I’ve worked with dental investigations both – all over the United States… Basically my background is in Medicaid fraud.” (Superior Court of the State of California, in the County of San Diego, Sept 7, 2022, case no. 37-2021-00049304, in the matter of Martinez and Tuso).

Few would dispute Martinez’ knowledge and expertise in the field of dental Medicaid fraud.

Aldairi has never been disciplined by California regulators related to Borrego Health, or Illinois consent orders and failure to comply with consent orders in Illinois (which concurrently represent violations in California). Although he was disciplined for an unrelated violation by the DBC, Aldairi maintains Medi-Cal credentialing and a California dental license.

Eye-Rolling Bankruptcy Creditors

Daniel Kramer, chief of media and public relations for Borrego Health, stated for Dentistry Today, “Parties included on the list of noticed parties are not all creditors and do not necessarily have claims against the debtor (Borrego Health). The list represents parties who may have been vendors to Borrego Health in recent years. The list also includes current and former employees who may have incurred expenses on Borrego Health’s behalf using a personal account in recent years.”

The listing of creditors is beyond astounding and points to scandal on a massive scale. The number of high-profile Las Vegas casinos and resorts is disturbing, especially for a nonprofit IRS 501c company.

These include:

  • Caesar’s Palace
  • Mandalay Bay Resort & Casino
  • MGM Grand Hotel & Casino
  • Mirage Hotel & Casino
  • Paris Hotel & Casino
  • Planet Hollywood Resort

Locally, the Spotlight 29 Casino in Coachella, California, earned an entry on the creditors’ bankruptcy role. Not making this record was another neighboring gambling casino, Sycuan Casino. However, this casino was mentioned in formal discipline considerations of the DBC against Aldairi, in a matter totally unrelated to Borrego Health.

“Complainant alleges that on or about September 10, 2019, the Sycuan Tribal Police arrested Respondent (Aldairi) at the Sycuan Casino for being drunk and disorderly in public. He was loud and disruptive, and refused to leave the casino voluntarily even after police arrived. He asked the police to arrest him.”

Other questions can be raised by the extensive number of party supply companies, flower shops, and event planning firms which made the creditors’ register. Additionally, a musical instrument sales outfit (Guitar Center) was included. Rarely does one consider a FQHC nonprofit healthcare provider as “party central.”

The creditors also included an extensive number of auto dealers, car detailing companies, as well as auto repair and towing enterprises. One would reasonably expect auto leasing, purchasing, and maintenance for vehicles utilized by home health nurses, and social services for homebound patients. It might include transportation services for non-ambulatory patients to and from Borrego Health clinics. Kramer stated, “Borrego Health owns and leases vehicles for a variety of care-delivery and business purposes.”

This vast listing related to autos should not include private transportation vehicles for senior Borrego Health officers and directors, especially of a nonprofit entity. A forensic accounting would be reasonably essential for determination, based on the troubling history of Borrego Health.

Party Central at Borrego Health

Luxury hotels and resorts locally, nationally, and internationally were also named. Moreover, limousine services and airlines also were included.

Some are cited as follows:

  • Alaska Airlines
  • American Coach Limousine (Chicago)
  • Caribe Royal Resort (Orlando, Florida near Disney World)
  • The Colony Palms Hotel and Bungalows (Palm Springs, California)
  • Diamond Limousine (Hughesville, Maryland)
  • Gaylord Hotel Opryland Resort (Nashville, Tennessee)
  • Hyatt Regency Huntington Beach Resort
  • Hyde Resorts (Hollywood, Florida)
  • InterContinental Hotel (luxury hotel near French Quarter in New Orleans, Louisiana)
  • Jake’s (fine dining in Palm Springs, California)
  • Julian Gold Rush Hotel (Julian, California)
  • La Casa Del Zorro Desert Resort and Spa (Borrego Springs, California)
  • Mears Transportation (limo transportation in Orlando, Florida)
  • Miracle Springs Resort & Spa (Hot Springs, California)
  • Palm Springs Riviera Resort & Spa (a/k/a Margaritaville Resort)
  • The Royal Crescent Hotel & Spa (Bath, United Kingdom)
  • Sonesta Hotel (Philadelphia, Pennsylvania)
  • Southwest Airlines
  • The Mission Inn Hotel and Spa (Riverside, California)
  • United Airlines
  • The Watergate Hotel (Washington DC)
  • The Willard InterContinental Hotel (luxury historical hotel near White House in Washington, DC)
  • Walt Disney Resort (Orlando, Florida)
  • Westgate Lakes Resort and Spa (near Walt Disney World and Sea World Orlando)

An unusual number of creditors were recreational vehicle (RV) sales and service companies. A specialty custom trailer hitch supplier was included as well.

Borrego Health does support a number of mobile medical and dental clinic vehicles, which may explain some of this expensing. Kramer advised that Borrego Health operates ten mobile health units. Again, a forensic accounting would be necessitated to ensure Borrego Health resources were not diverted.

Construction & Land Development

Apparently out-of-place were various firms focused within the construction and land development industry. These included a roofing company, an asphalt supplier, multiple plumbing and backflow companies, a variety of industrial crane operators, lumber supply, and a host of landscaping and pool companies.

Further forensic investigation might confirm or deny, whether all or some of these construction and landscaping operations were solely for structures owned and operated by Borrego Health. Kramer stated, “Borrego Health operates multiple facilities throughout its service area.”

A nonprofit healthcare corporation should never be subsidizing expenses which should rightfully be borne by others, particularly in construction and land development. A FQHC should not be paying over-inflated rental fees, especially on properties which they developed and maintain. Borrego Health should not be subsidizing the construction costs of unrelated projects. Such an unlawful activity might be viewed as a form of money laundering and fraud, perpetrated by those benefiting.

Dental

The creditors’ list also cited over 20 outsourced dentist contractors and clinics. These private sector dentists and their clinics were sometimes listed as “disputed,” which implied allegations of Medicaid abuses and fraud, and/or a failure to meet terms of Borrego Health provider contracts. Two of the disputed entities are the aforementioned Aldairi and 40/30 Dental.

Another listed dentist creditor holds a public record disciplinary action from the Alaska Board of Dental Examiners, which resulted in profound injury to a patient. This did not elicit the BDC to sanction his dental license. He continues to maintain Medi-Cal credentialing under the California DHCS. Obviously, any due diligence by Martinez and his crew acting at the behest of Borrego Health did not exclude him as a contracted provider.

His dental group practice (small dental service organization – DSO) includes other troubling practitioners with a CDB history of “Malpractice Judgement.” One is left to speculate on the judgement of Martinez and Borrego Health to contract with a questionable DSO and their doctors, without intensive on-site clinical record inspection and monitoring of patient care, even assuming Borrego Health decided to contract with such dubious dental providers.

A different contracted dentist serving patients of Borrego Health had prior DBC public record disciplines related to:

  • “Epinephrine induced temporary myocardial (stunning), but her heart suffered no permanent heart damage.”
  • “Respondent (dentist) recorded no periodontal charting on Patient’s teeth. Based on his examination and x-rays, Respondent recommended cleaning Patient K.T.’s teeth, placing fillings in two teeth (teeth nos. 2 and 15), and a periodontal program, including deep cleaning. Patient K.T.’s parents sought a second opinion from Drs. R and S. Both doctors agreed that a periodontal program, including a deep cleaning was not necessary. Additionally, Dr. S determined that tooth no. 2 did not have a cavity or require a filling.”

Although this dentist’s license was revoked and subsequently immediately reinstated by the DBC, one might assume his Medicaid credentialing by DHCS would receive close monitoring, if not suspension or revocation. Similarly, one might question the wisdom of Borrego Health entering into Medicaid patient care contracts with this provider, without extremely close observation, if at all, for such a vulnerable Medicaid patient population.

The Borrego Sun reported on an extensive list of civil and criminal allegations against Borrego Health’s contracted dentists. These doctors and one dental assistant (allegedly providing unlicensed dental services) were named on the Borrego Health bankruptcy creditor list.

Two dentists, who were supervised by Borrego Health dental director Martinez, also made the extensive bankruptcy creditor tally. These were Martinez’ immediate subordinate, Nithya Venugopal, DMD, and his hand-selected investigator Elias Koutros, DDS, from Rhode Island.

Venugopal, formerly assisted directly under Martinez, is today serving with Borrego Health’s new Compliance Committee after the company shakeup. According to the Borrego Health website, “Under her leadership, she will oversee her team in the review of Medicaid provider activities, audit claims, and educate providers and others on the Denti-Cal program as it pertains to FQHC’s in our state.”

As reported by the Borrego Sun, “She failed in that role, for whatever reason. While like many others who remained silent about what they had to know was illegal, including former members of the Executive Committee of the Borrego Health Board of Trustees, it isn’t fair to place responsibility on her, but so many people, like her, had a choice to do something or go along. And unfortunately, they made the decision to go along, either for job security, friendships, or because for so long there were no repercussions.”

“One culprit of questionable character, Dr. Elias Koutros, is no longer being paid for medical (dental investigative) services. The doctor holds licenses in Rhode Island, and two other states (California dental license issued September 2019), and allegedly audited the Borrego Health dental clinics, even though a medical (dental) doctor, living on the East Coast. Go figure that one out? He was later hired at Borrego Health and listed in the foundation’s IRS reports as one of the highest earning personnel that was not an officer. Evidently, he had friends in high places.”

Martinez reached the creditor sheet as well, along with Maura Tuso, DMD, MS. Both are currently embroiled as adversaries in the previously cited civil legal case. The action involves a suit and countersuit for alleged harassment and restraining orders.

Martinez also serves on the Dental Hygiene Board of California (DHBC) and was formerly president of that state regulatory board. He regularly confers and collaborates with its sister state regulatory agency, the DBC. In this capacity, Martinez has routine ongoing contacts with board members and board directors appointed by Governor Gavin Newsom, as well as board attorneys assigned by the California Attorney General’s Office.

Nikki Symington of the Borrego Sun reported on November 11, 2021, “How did Dr. Timothy Martinez, Borrego Health’s Chief Dental Officer, liaison between Premier Healthcare Management and Borrego Health, not know there was cheating going on right under his nose? An intelligent man with a solid resume, Dr. Martinez probably helped Bruce Hebets (former Borrego Health CEO) develop the idea (this unique form) of contract dentistry and the management structure. Martinez has a professional history of advocacy for contract dentistry as a way for dentists to benefit and reach more of the underserved.”

“Actually, the one thing Martinez can’t say is that he didn’t know about Aldairi’s illegal activities. Dr. Maura Tuso, a dental endodontist, went to great lengths to alert him and others that Dr. Aldairi was breaking the law.”

Daryl Priest and Companies

Noted Riverside and San Diego Counties real estate and land developer, Daryl Priest, some of his companies and his son, Nicholas Priest, were also named on the bankruptcy creditors’ filing. Allegations in a lawsuit of Borrego Health against Daryl Priest’s dental Medicaid billing firm, Premier Healthcare Management (Nicholas Priest was former Executive Director) contend the company grossly overcharged Borrego Health for outsourced billing services. Allegedly, Priest’s Summit Healthcare Management, Inc. was a mirror image with medical Medicaid billing services. The Borrego Sun produced a good summary of that lawsuit.

Each claim processed was allegedly charged up to $25/ per billing form submitted. Plaintiffs contend this represented a method of money laundering, to enrich those controlling the lucrative business of Medicaid fraud by a FQHC. Make no mistake, Medicaid fraud is by far, the most lucrative business model in the dental industry.

All the while, corporate officers and directors at Borrego Health initially reported no malfeasance, for a prolonged period of years. Eventually, after federal and state investigations, a massive shakeup in corporate control of Borrego Health occurred. If and when insider whistleblowers initially stepped forward, at personal risk to themselves and their careers, they were ignored, discredited, and silenced.

Investigative reporter for the Borrego Sun Nikki Symington stated, “Simply leasing out the non-profit status for a fee and the ability to access federal and state funding allows Borrego Health to not just grow, but increase revenues exponentially. All without the headaches of actually delivering health or dental services.”

“Bruce Hebets (Borrego Health’s founding CEO) originally put forward the concept of getting out of providing services by simply facilitating private providers to benefit from Borrego Health Foundation’s non-profit status for a fee. Using Premier (Healthcare Management) as the middleman manager of the private providers, the (Borrego Health) Foundation has expanded this program beyond Medicaid dental services to actual Medicare health services. Anderson (Borrego Health board member and former chairperson) admitted, at least three clinics are not being operated by Borrego Health, but by private providers, under contract with Premier.”

“The reason is: It costs to provide services, and management of clinics requires expertise and work.”

Rents paid by Borrego Health for real estate holdings of Daryl Priest and his companies are also the focus of current litigation. Plaintiffs contend property rental fees were intentionally overinflated, to launder money to Priest holdings as alleged in a civil RICO lawsuit.

Investigative reporter Symington offered, “Can the (Borrego Health) Foundation recover the millions of dollars Hebets and his successor, former CEO Mikia Wallis, gave to the likes of Daryl Priest? And, not just for the $11.5 million in inflated rent fees, the subject of Borrego Health’s current legal suit. But the estimated $100 million sucked from the Borrego Health budget and the clinics by Priest’s privately-owned company – Premier Healthcare Management.” (Note: Many consider those exceptionally low dollar estimates of the actual alleged fraud.)

Management

Borrego Health’s founding CEO was retired Port of San Diego Police sergeant, Bruce Hebets, who died in 2019. That year he was paid the salary of $1.9 million. The year after his death in 2020, Hebets was paid over half a million dollars. He held no prior background or experience in healthcare or corporate financial administration. He was purported to have been a close personal friend of local real estate entrepreneur and philanthropist, Daryl Priest.

The late Bruce Hebets was not cited on the bankruptcy creditor list, but his wife and heir Karen Hebets was named twice. She was not only heir to her late husband’s (Bruce Hebets’) estate, but also served in administration of Borrego Health. Obviously, ethical considerations of nepotism were not a factor worthy of review.

According to the Borrego Sun, “She was given $3 million ‘to support and sponsor,’ and loaned another $460,000 plus, by Borrego Health to a private healthcare network the Hebets’ founded called, Borrego Independent Physicians Association (BIPA). The BIPA advertised dental, pharmaceutical and OBGYN services in San Diego Directories.”

Borrego Health submitted on its 2019 IRS form 990 form, that dental encounter fees accounted for 63-65% of its income, which included nearly 900,000 patient visits.

Consulting and Insurance Contractors

The standouts on the bankruptcy listing included James Hebets, brother to the late Bruce Hebets, The Hebets Company, and NFP Insurance Services.

James “Jim” Hebets is the founder and president of the Hebets Company, which is today in the portfolio of NFP.

Their website espouses, “The firm specializes in the areas of executive compensation and fringe benefit consulting, business succession planning concepts, wealth creation and estate preservation strategies and the facilitation of the purchase of extremely large amounts of life insurance.”

The Hebets Company openly promotes “estate planning for the exceptionally wealthy” and “… facilitating a strategic national approach to Federally Qualified Health Centers. The Hebets Company has over 45 years of experience in delivering some of the highest quality compensation and benefits consulting and service to healthcare executives and providers around the country.”

“The Hebets Company’s Executive Compensation and Supplemental Fringe Benefits division assists these enterprises in designing and implementing innovative compensation and benefit programs for purposes of recruiting and rewarding those key executives who are instrumental to the profitability of the company. Legislative changes over the years have repeatedly reduced the qualified plan benefits that can be allocated to this select group of highly compensated employees resulting in ‘reverse discrimination.'”

A primary focus of the Hebets Company is to maximize compensation packages for officers and directors of nonprofit FCHCs.

“We will evaluate the current FQHC compensation and retirement models, educate the FQHC executive team along with the Board of Directors regarding the compensation opportunities specific to not-for-profit organizations, and make a suggestion for the most appropriate model applicable to the specific FQHC. These options include a wide variety of governmentally sanctioned programs that have been codified in the Internal Revenue Code under the following sections: 162(b), 457(b), 457(f), 403(b), split dollar plans, executive/employee bonus programs, and other bonus retirement hybrid strategies. Additionally, there are other insurance and benefits based programs available to employees of not-for-profit FQHCs that may warrant exploration.”

In essence, compensation, and benefits for senior personnel of FQHCs are not reported as salary on IRS form 990, Schedule J, but shift to less transparent mechanisms. Only a deep forensic accounting could determine the degree to which Borrego’s officers and directors were truly remunerated.

Word has definitely gotten out about the lucrative positions of senior management generated within nonprofit FQHCs and how The Hebets Company can facilitate wealth creation.

“Today, we’re fortunate to serve more than thirty FQHCs across the country, including several of the ten largest.”

The Hebets Company is deep into reversing “reverse discrimination” foisted upon the super-wealthy.

What happened at Borrego Health may only be a tiny segment of a much larger pattern of deception and abuses, on a national level within the corporate nonprofit FQHC industry.

CONCLUSION

The size and scope of happenings at Borrego Health impact every taxpayer, not only in California, but in the country. Medicaid is jointly funded through state and federal moneys. The US government might be entitled to recover mismanaged Medicaid funds via claw-backs, from the State of California. Forensic accountants from the IRS and FBI should place this case front-and-center. The California Department of Insurance should analyze exactly how officers and directors of Borrego Health may have received “hidden” compensation.

State regulators inclusive of the DBC and California’s DHCS were either asleep-at-the wheel, or more likely tacitly complicit. The US Health and Human Services Office of Inspector General has repeatedly repudiated “Pay-&-Chase” has a highly ineffective means for recovery of taxpayer money. State authorities appointed by the California Governor and Attorneys General Office arguably facilitated a coverup. Dentist wrongdoers were either ignored or sanctioned for unrelated actions. Martinez, to this day, serves on a dental state regulatory agency.

Priest is a board member in the Lincoln Club of San Diego County. This Republican Party organization is highly influential in state politics and facilitates political donations and candidate support.

One of the few heroes in this report is Nikki Symington, reporter with the Borrego Sun. In the old-school tradition of small town print journalism, she has covered every local story from the annual Mother Goose Parade, to the depth of the scandal with Borrego Health.

Her exposés have not gone without severe criticism. Borrego Health brought employment to an economically depressed community. Outlays for overhead expenditures by Borrego Health supported numbers of local and regional small businesses, from car dealerships, to restaurants, to construction trade companies.

Social media in her local community of Borrego Springs went into attack mode against Symington. Some were rather vicious.

Symington responded publicly in print, “Sometimes, bad news is actually good news. Especially, when it offers an opportunity to correct illegal behavior, reconcile conflicting facts and opinions; and lead to a real community debate about the realities that will determine the future of health care in Borrego Springs.”

DISCUSSION

Nikki Symington & Borrego Sun

Dentistry Today conducted an exclusive interview with Symington. We traversed a variety of topics. As a news reporter in a smaller disadvantaged community, she is the “go to” person for local citizens to access information. She represents an historical throwback when the media held esteem and value with the public.

To follow are excerpts from that interview.

“Keep in mind the Borrego Springs clinic, which is where I can make onsite evaluations as to patient care, provides the only medical services available within a 70-mile drive to major cities – and providers. There are no private doctor’s in Borrego.”

“Well, since the large amounts of money generated from the Premier Healthcare Management/contract Dentist scam (growth of about $100 million annually over five years) wasn’t being invested in our local clinic, per our observations, the Borrego Springs Clinic has not been able to keep a local doctor on site for the past 3-years. Without a doctor with whom patients can consistently identify with and trust there is a severe loss of medical help, miscommunicated case managements, mishandled prescription requests, difficulty getting referrals, and a general lack of trust.”

Symington continued, “People in Borrego call me and ask, ‘Is the clinic open, how long will we have a clinic, is there a doctor yet?’  ‘Why isn’t the clinic answering its phone?’ Now with the bankruptcy, my usual callers have changed from people needing medical information to employees questioning me about the ‘status of their employment and benefits.'”

“The Borrego Springs clinic, the original and only FQHC, on which Borrego Health built its empire on, has been deteriorating in both primary services and medical equipment prior to the investigation. In fact, the question of how Borrego Health could make so much money and run our clinic without a nurse practitioner, mental health provider, and doctor at the beginning of COVID was what got me wondering about their finances. Also, the clinic did not even have a wheelchair, had a dead heart monitor, and other deficiencies in medical equipment and professional staff.”

“Due to the clinic’s impotence, Borrego Springs residents relied on a collection of rural paramedics to provide the original vaccines. A major loss has been the children and youth’s preventive programs that were run in coordination with the local school district, this included well health checkups and dental care. With an 80 percent Mexican population, a large percentage of parents who do not speak English, this program stressed nutrition to fight the rash of obesity, and other aspects of preventative health care that is much needed and is currently no longer available.”

Symington added, “The state and, especially, the federal monitors failed miserably. They had 10-years of seeing red flags and, admittedly, did nothing, until the Borrego Sun wouldn’t stop writing about fraud, other illegal activities, and violations of Medicaid and Medicare regulations.”

“I have asked the federal department and agencies, about their obvious role in missing such as large theft of public health insurance, and received replies copied from their websites about their programs and how they monitor… yakety yak…” continued Symington. “I am not sure this type of large-scale fraud could have happened without support from within the government. I have no proof, except issues with the state Dental Board failing to protect the public by issuing licenses and protecting dentists with court records and bad histories.”

“My other observation is: How could they be so arrogant, actually reporting the outrageous amounts dental contractors were making, (Dr. Husam Aldairi, a private dental contractor, made $8 million in 2020); listing salaries for 200 people over $100,000 and inflated wages for officers, managers, friends, and family, in their IRS 990 reports? Who would be so brazenly proud of violations of FQHC regulations unless they felt protected?” added Symington.

“All it took was reading two IRS form 990s, and the auditors’ reports, and I knew there was something wrong, and I am far from a forensic auditor, just a curious person. I am afraid, we will never know who conspired and was complicit with Borrego Health in the state and federal governments, because the governments protect their own. And that is a shame.

“Furthermore, I have a theory only, that perhaps the reason the state Department of Health Care Services wants to shut Borrego Health down quickly is, so no further investigations can link government officials.”

Symington concluded, “I would add, this investigation made me sick. The amount of greed and self-serving was insatiable. I know I have a very jaundiced view of all public health and its particular vulnerabilities to fraud, especially towards some foreign nationals.”

ABOUT THE AUTHOR

Dr. Michael W. Davis practices general dentistry in Santa Fe, NM. He also provides attorney clients with legal expert witness work and consultation. Davis also currently chairs the Santa Fe District Dental Society Peer Review Committee. He can be reached at MWDavisDDS@Comcast.net.

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Medicaid and Medicare hotline workers strike for higher pay and support

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]: Maximus employees are looking to get paid more to work in call centers that are helping Medicaid members, on the eve of the PHE wind-down no less.

 
 

 
 

Clipped from: https://www.npr.org/2022/11/01/1132931674/medicaid-and-medicare-hotline-workers-strike-over-pay-and-working-conditions

 
 

Workers who handle calls about Medicare and Affordable Care Act health plans walked off the job in Louisiana, Mississippi, Kentucky and Virginia today, demanding better pay and a less stressful workload.

The workers are employed by Maximus, a federal contractor. They are asking for a pay raise to $25 per hour and more breaks between calls. The call center workers answer about 15 calls per day, averaging about half an hour each. On busy days like today, which is the first day of open enrollment for the Affordable Care Act, workers said they can take up to 20 calls.

Maximus had operating income of $408 million in fiscal 2021, and has 34,000 employees globally. Sylvia Walker, a customer service representative who participated in the walkout in Bogalusa, Louisiana, said she feels she is not paid enough for how demanding her job is.

“You can wear so many hats on any given call. There could be a crisis,” she said, after which call workers are expected to file a report then turn to the next caller. “We are a counselor, we’re the doctor, we are the lawyers. We are everything to these people.”

Two years ago, she said one woman on the other end of the phone expressed an intention to commit suicide.

“We’re not equipped for that,” said Walker. Maximus said employees are trained to use scripts if a caller discusses the possibility of suicide.

Walker, who is 68, said she has been working for the company for nine years and has received pay bumps twice. She currently makes just over $17 per hour and works 40 hours per week. The Bogalusa resident is eligible for Medicare, but she said she can’t afford to retire yet.

In a statement, Maximus said it “welcomes the opportunity to work directly with our employees and discuss and hopefully resolve their concerns. Over the past several years, Maximus has improved pay and compensation, reduced employees’ out-of-pocket health care expenses and improved work processes and safety.” The company also said it did not anticipate any disruption in services.

Call center workers, who organized with support from labor union Communications Workers of America, delivered their demands to company leadership five days before the walkout. Employees at Maximus do not belong to a union, even though many have been organizing for months. The extent of worker participation in the walkout is under dispute. CWA said that more than 400 workers went on strike at four call centers. Maximus said that fewer than 200 employees participated in the job action.

“I want to see a union before I leave this place,” said Walker.

Camille Wade, 31, who has worked at the Bogalusa location for eight years, said she has experienced racism during calls.

A majority of Maximus workers across U.S. locations are women and people of color, according to a release by the Communications Workers of America.

“Sometimes if they’re able to tell and pick up by my voice that I am a Black woman, they’ll automatically want to go above me,” said Wade, who now works for Maximus’ internal support group after she was promoted from a customer service representative.

But
she said Maximus offers no strategies for preventing abusive or dismissive calls. “If we don’t put up with the abuse, we get fired.”

Workers in Bogalusa and two other Maximus locations went on strike earlier this year claiming poor working conditions and inadequate protection against COVID-19. Several days later, CWA filed a complaint to the National Labor Relations Board against Maximus for intimidating workers who walked out.

Maximus says employees can request bathroom breaks at any time and can take two 15 minute breaks in addition to their half hour lunch break.

But for some workers, like Walker, it’s not enough. “You can get someone who talks you down or looks down at you as if you’re less than,” she said. “Dignity is something that is important.”

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FWA (CO) Pueblo Woman charged for more than 500,000 dollars of 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]: She filed a LOT of bogus telehealth claims.

 
 

 
 

Clipped from: https://www.koaa.com/news/covering-colorado/colorado-department-of-law-files-medicaid-fraud-charges-against-a-pueblo-woman

 
 

PUEBLO, CO — Attorney General Phil Weiser announced charges against a Pueblo woman on Thursday, October 28th. The Colorado Department of Law filed the charges for Medicaid fraud.

46-year-old Renee Fosano is accused of submitting Medicaid claims for reimbursement for services that were never rendered. The State says that between March 3, 2020, to April 12, 2020, Fasano routinely filed claims as the owner of Southern Colorado Telehealth amounting to a total theft of approximately $577,935.82.

According to the Pueblo County District Court affidavit, Fasano took the Medicaid billing information of patients of her former employer Castillio Primary Care where she worked as a biller, and used this information to make fraudulent claims stating patients had rendered her services.

Fasano has been charged with two accounts of Medicaid fraud, one count as a class three felony and one as a class five felony.

“Those who steal from our Medicaid system take money away from some of those in our state who need it most to ensure they have proper medical care,” Weiser said. “My office will continue to hold accountable those who seek to take advantage of such a critical service.”

The Attorney General’s Medicaid Fraud Control Unit is dedicated to protecting the integrity of the system that provides healthcare to the most vulnerable Coloradans. It accomplishes this through the investigation and prosecution of Medicaid provider fraud as well as the investigation and prosecution of the abuse and neglect of Medicaid clients in non-institutional settings as well as the abuse and neglect of patients in institutions that receive Medicaid dollars. To report potential Medicaid fraud, click here or call (720) 508-6696.
____

Watch KOAA News5 on your time, anytime with our free streaming app available for your Roku, FireTV, AppleTV and Android TV. Just search KOAA News5, download and start watching.

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FWA (OH)- Mansfield Medicaid Fraud Case Yields Prison Sentence

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]: He stole $1.6M with bogus Medicaid claims for counseling services.

 
 

 
 

Clipped from: https://www.ohioattorneygeneral.gov/Media/News-Releases/November-2022/Mansfield-Medicaid-Fraud-Case-Yields-Prison-Senten

(MANSFIELD, Ohio) — The owner of G L Tate & Associates, an outpatient treatment center for substance-use disorders in Mansfield, has been sentenced to 6 years in prison for defrauding the Ohio Department of Medicaid and will repay $1.57 million, Ohio Attorney General Dave Yost announced today.

“Cases like this make my blood boil,” Yost said. “This money was designed to help people who are struggling with addiction but instead, he was just stealing it. He deserves every last day of this sentence.”

Geron L. Tate, a Mansfield resident, was sentenced in Richland County Common Pleas Court after pleading guilty to one count of aggravated theft, a second-degree felony, and one count of Medicaid fraud, a third-degree felony.

As part of the plea agreement, Tate will pay $1,572,386.21 in restitution to the Department of Medicaid’s benefits program.

Investigators with Yost’s Health Care Fraud Section determined that Tate billed the Ohio Medicaid program for counseling services that were never rendered. Based on recipient interviews, investigators determined that Tate submitted approximately 5,000 claims for services that were not provided. Additionally, investigators established that Tate billed for services while he was out of state, and also overbilled for hours in excess of 16 hours of services per day. Agents identified 25 separate times where Tate was traveling out of state, yet he billed that he was providing counseling services in Ohio at the same time.

The Ohio Attorney General’s Medicaid Fraud Control Unit is responsible for the investigation and prosecution of health care providers accused of defrauding the Department of Medicaid’s benefits program.

The Ohio Medicaid Fraud Control Unit receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award totaling $14,858,772 for Federal Fiscal Year (FY) 2023. The remaining 25%, totaling $4,952,924 for FY 2023, is funded by the Ohio Attorney General

See the below links for soundbites from AG Yost:

“This case makes my blood boil because this guy is cheating”

MEDIA CONTACT:
Steve Irwin: 614-728-5417

-30-

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FWA (MN)- Federal Jury Finds Maple Grove Man Guilty of Wire Fraud, Aggravated Identity Theft in $1.4 Million Medicaid Fraud Conspiracy

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]: He and his co-conspirators falsified claims for mental health services and interpreter forms.

 
 

 
 

Clipped from: https://www.justice.gov/usao-mn/pr/federal-jury-finds-maple-grove-man-guilty-wire-fraud-aggravated-identity-theft-14-million

ST. PAUL, Minn. – A Maple Grove man has been convicted by a federal jury for his role in a $1.4 million Medicare fraud conspiracy, announced United States Attorney Andrew M. Luger.

Following a four-day trial before U.S. District Judge Eric C. Tostrud, Eskender M. Yousuf, 40, was convicted on all seven counts of the superseding indictment, including conspiracy to commit wire fraud, wire fraud, and aggravated identity theft. The charged conspiracy consisted of nine total defendants. Six of Yousuf’s co-conspirators pleaded guilty prior to trial and two remain fugitives from law enforcement.

As proven at trial, Yousuf was a mental health practitioner who worked with Live Better, LLC, a patient services company with offices in Roseville and Minneapolis. As part of the scheme, Yousuf and his co-conspirators knowingly prepared and signed client progress notes for mental health services—and related interpreter verification forms—that were not actually rendered and submitted claims to the Minnesota Medicaid program for reimbursement of mental health services and the related interpretation of those services. As a result of the false and fraudulent claims, the Medicaid program paid more than $1.4 million for services that never occurred. A sentencing hearing will be scheduled at a later time.

This case is the result of an investigation conducted by the FBI; the U.S. Department of Health and Human Services, Office of Inspector General; and the Minnesota Attorney General Office’s Medicaid Fraud Control Unit.

Assistant U.S. Attorneys Angela M. Munoz and Jordan L. Sing tried the case.

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FWA (CT)- Woman who helped CT autistic kids gets 3 years for Medicaid scam

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]: When she was busted for Medicaid fraud at the business she owned, she went and did the same thing as a silent partner at another business- while out on bail. Twice.

 
 

 
 

Clipped from: https://www.ctpost.com/news/article/Helping-Hands-Bridgeport-Medicaid-scam-17551318.php

 
 

A former Connecticut resident who continued to defraud Medicaid even after she was charged with related offenses has been sentenced to three years in prison, according to the U.S. Department of Justice.

Nicole Steiner, formerly known as Nicole Balkas, 33, was also sentenced to three years of supervised release once her prison term ends and was ordered by U.S. District Judge Jeffrey A. Meyer to pay $505,955.56 in restitution, federal officials said. Steiner’s scheme cost Medicaid a total of $551,311.85 in losses, the Justice Department reported in August.

Steiner owned and operated Helping Hands Academy LLC, a Bridgeport business that provided applied behavior analysis services to children diagnosed with autism spectrum disorder and served as a provider for the Connecticut Medicaid Program, according to federal officials. Between December 2018 and October 2020, Steiner submitted fraudulent Medicaid claims for applied behavior analysis services that were never provided or not provided as indicated in the claim, officials said.

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Officials said Steiner, a former Stratford resident, also posed as a former employee to submit fraudulent claims in 2020. 

In August 2020, the state Department of Social Services, which administers the Connecticut Medicaid Program, terminated Helping Hands as a provider, according to court documents. Steiner made false statements and submitted an altered document in an attempt to reinstate Helping Hands as a provider and receive compensation for previously submitted claims, officials said.

Steiner pleaded guilty to one count of health care fraud on April 28, 2021, according to officials. She was released on a $50,000 bond pending sentencing. 

While out on bond, Steiner served as a “silent partner” in a company similar to Helping Hands named New Beginnings Children’s Behavioral Health LLC, according to officials. Steiner was put in charge of billing Medicaid for services rendered, managing payroll and recruiting and screening employees. She resumed submitting fraudulent Medicaid claims for applied behavioral analysis services that were never provided, officials said.

Steiner was arrested on May 2, according to officials. She pleaded guilty to a second count of health care fraud on July 29 and was released on a $250,000 bond pending sentencing, officials said.

While out on bond a second time, Steiner submitted applications indicating she lived in Bridgeport to obtain Medicaid coverage for her and her children, according to officials. However, she was living in New Jersey at the time, officials said.

Steiner was remanded to federal custody after sentencing. 

caroline.tien@hearst.com