Tuesday, November 25, 2014

Schmidt, federal authorities crack down on home health care fraud in Kansas

KANSAS CITY, KAN. – Kansas Attorney General Derek Schmidt and the U.S. Department of Health and Human Services/Office of Inspector General have joined forces to crack down on home health care fraud in Kansas and have obtained their first criminal conviction from the joint operation, both offices announced today.

For several months, the offices have worked together on “Operation No Show,” the cooperative investigation of fraudulent billing to Medicaid for personal care services provided in Medicaid beneficiaries’ homes.

The focus of the multiple investigations has been on abuse of Medicaid’s Home and Community Based Services program that pays personal care attendants to assist qualifying Medicaid recipients with general household activities and personal care.

The joint enforcement effort led to the conviction last week of Doris Betts, 55, Kansas City, Kan., who pleaded guilty to health care fraud in U.S. District Court. Both parties agreed to recommend a sentence of 18 months in prison followed by three years of supervised release and restitution to the Kansas Medicaid program in the amount of $251,573.32.

The investigation revealed that between January 2008 and December 2013, Betts falsely billed for providing in-home services to two or more clients at the same time in different locations, while the client was hospitalized, and while Betts was instead at her own medical appointments. During this period, Betts billed for more than 750 work days that exceeded 24 hours, the highest of which topped out at 39.5 hours.

Betts billed for a variety of services, including personal care services, sleep cycle support, day support and residential support. By using multiple billing agencies, Betts was able to bill for services that overlapped. Sentencing has been scheduled for February 6, 2015.

“The personal care attendant program provides important in-home services for Medicaid recipients who need help to remain in their homes,” Schmidt said. “When the program is abused and taxpayers are defrauded, vital resources are taken away from Kansans who are truly in need. We are working cooperatively with our federal partners to protect this joint federal-state program, and we intend to remain focused on finding and prosecuting those who defraud taxpayers by lying about the work they have done and submitting false bills.”

Gerald Roy, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations for Region 7, Kansas City, coordinated the federal part of the joint operations.

“The Office of Inspector General has built a strong partnership with the Kansas Attorney General’s Office, and the Medicaid fraud and abuse division to keep the Kansas Medicaid program free from fraud, waste and abuse,” Roy said.  “Unfortunately, criminals often prey on Medicaid and target programs such as Home and Community Based Services for personal gain with shameless disregard of the consequences. Their fraudulent activities are adversely impacting the state’s budget, straining critical, limited resources, and putting our vulnerable beneficiaries at risk. These 12 prosecutions send a clear and concise message that the actions of those who steal from our programs will not be tolerated. Kansans can expect our joint efforts to continue, with ‘Operation No Show,’ and future initiatives demonstrating that federal and state administered healthcare programs are off limits to fraud perpetrators.”

 Nationwide, the personal care attendant program has been the number-one source of fraud complaints to state Medicaid fraud units.

In addition to the Betts case, “Operation No Show” has led to 11 other criminal cases being filed by Schmidt's office. Examples of the fraud alleged in pending cases charged in Wyandotte, Nemaha, Johnson, Sedgwick, Neosho, Ford and Shawnee counties include:

  • Personal care attendant and consumer conspired to claim provision of home health services at times when the care attendant was working for another employer, and then split the proceeds of the home health services claims.
  • Consumer decreased the times services were reportedly provided by the personal care attendant in order to report more time provided by his/her mother so that the mother would receive more money.
  • Personal care attendant claimed to be providing home health services while the consumer(s) were in the hospital. Care attendant also claimed services were provided after a consumer died, and during a period of time while the care attendant was incarcerated.
  • Personal care attendant claimed to provide more than 1,600 hours of care to two different consumers at the same time, using two different billing agencies which made it difficult for the billing agencies to identify the fraudulent claims.
  • Charges are merely accusations. Individuals are presumed innocent unless and until proven guilty.

Other joint investigations are ongoing. The cases are being jointly investigated by federal and state authorities and prosecuted by the attorney general’s Medicaid fraud and abuse division.