Home Care Medicaid Fraud Developments in Kentucky, Virginia, and Ohio
June 28, 2013 02:50 PM
The National Council on Medicaid Home Care (the Council) reports on recent developments in Medicaid fraud, including: 1) alleged fraud of caregivers for the disabled in Kentucky; 2) convicted fraud of an owner of a personal care services company in Virginia; and 3) an Ohio governmental audit targeting home care.
On June 17, Kentucky Attorney General Jack Conway indicted two individuals for allegedly defrauding Kentucky’s Medicaid program. Kentucky charged William Qualls and Linda Smith with Devising or Engaging in a Scheme to Defraud the Kentucky Medicaid Program and Theft by Unlawful Taking Over $500 but under $10,000. The Office of the Attorney General claims that both defendants submitted false timesheets to Medicaid when working as caregivers for the disabled. If convicted, each defendant faces up to $10,000 in fines and 10 years in prison.
To see the press release in Kentucky, click here.
On June 13, Angie Gilchrist was sentenced to 33 months in prison, an additional three years of supervised release, and nearly $295,000 in restitution for defrauding Virginia’s Medicaid program. She had pled guilty to health care fraud on February 19.
Gilchrist was the owner and operator of A-Z Alpha Omega In Home Personal Care Service, LLC (A-Z), which provided Medicaid respite care out of Suffolk, Virginia. Between October 2008 and October 2012, Gilchrist filed around 385 claims for respite care not rendered by A-Z to 38 Medicaid recipients. Gilchrist was reimbursed for $294,713 for these false claims.
To see the press release in Virginia, click here.
On June 13, Ohio released findings from an audit of the Department of Job and Family Services (the Department). While Medicaid is now administered by a separate state agency, it used to be administered by the Department.
The audit found that the state could save $20 million a year by investing in greater oversight to home care. Such oversight strategies include service verification and telephone monitoring. For example, the state would either require home care workers to call the state from the clients’ home phones, or use GPS-tracked cell phones. These precautions would in turn limit instances of fraudulent billing (either billing for services not rendered, or double billing). The audit also found that the state could save an additional $10 million a year if it demanded surety bonds from certain types of entities historically prone to committing fraud, like home care companies.
To see the full story on the Ohio audit, click here and here.
To see earlier Medicaid Council Report articles on alleged and established home care Medicaid fraud in Missouri and Rhode Island, click here, and in Alaska and Louisiana, click here.
States are increasingly seeing home care as “low hanging fruit” for payment recoveries - as the industry takes up a large percentage of the Medicaid budget while unfortunately containing an amount of fraud. Home care companies should continue to monitor developments in Ohio, which may be omens of future regulations there and elsewhere intended to prevent such fraud. Home care companies should welcome this possibility, and advocate on a state and federal level to help craft sound legislation that protects patients while putting the fewest restrictions on honest caregivers.
Fraud committed by individual caregivers, which the Council has been seeing with increased frequency, exists in a consumer directed program. Stakeholders should know that this might encourage state Medicaid programs to consider an agency model as a way of securing better oversight of individual caregivers.
Home care companies should be aware that despite increased enforcement efforts, home care companies and individual caregivers alike continue to face allegations of Medicaid fraud, primarily focused on billing for services not rendered. These trends have contributed to a movement to require background checks for caregivers, and stakeholders should actively engage in that process through the forums or state advocacy.
Also, to the extent that the alleged false billings relate to services where no documentation exists to support the billing, home care companies need to redouble efforts in that regard. Home care companies are encouraged to keep abreast of program integrity initiatives in their states, and to contact the Council with any questions or concerns.