Medicaid

August 1, 2018

Early Autism Project, Inc. (“EAP”) agreed to pay the United States $8,833,615 to settle allegations brought by whistleblower and former employee of EAP, Olivia Zeigler, that it submitted false claims to TRICARE (a military insurance program) and South Carolina’s Medicaid program for therapy services for children with autism. The therapy services were misrepresented or were never provided. EAP allegedly also created a program under which it billed Medicaid for functions that were not related to therapy services at all and permitted its therapists to regularly bill for more hours than they actually provided therapy services. Olivia Zeigler will be awarded $435,000. DOJ

July 26, 2018

New York announced guilty pleas by transportation company 716 Transportation, Inc., its president, and one of its drivers, in connection with a $1.2 million Medicaid fraud scheme. The company and its president admitted to billing Medicaid for transportation services that were either never provided or that violated Medicaid rules and regulations. NY AG

July 20, 2018

Attorney General Barbara Underwood announced a six month jail sentence and $1.5 million in restitution payments for Arkady Goldin owner of Value Pharmacy, Inc. for defrauding the New York State Medicaid program. Mr. Goldin had pleaded guilty to second degree health care fraud in June for entering into a kickback arrangement with a former hospital employee to steer prescriptions to Value Pharmacy. Value then submitted false claims to Medicaid for medications it never dispensed to patients. NY AG

July 3, 2018

A Virginia woman who owned several Medicaid support services companies has agreed to pay $1 million and to accept a lifetime ban on participation in the Virginia Medicaid Program as part of a settlement of allegations that she defrauded the program.  Dawn Sykes allegedly paid illegal kickbacks and sought reimbursement for services that were not provided or were provided to ineligible recipients.  The investigation was launched by a qui tam lawsuit under the FCA and Virginia Fraud Against Taxpayers Act, and the whistleblower will receive 18 percent of the settlement.  USAO EDVA

July 10, 2018

A Norwich behavioral health practice and its co-owners, a mother and her daughter who are both licensed behavioral health clinicians, agreed to a $300,000 settlement to resolve alleged violations of Connecticut’s False Claims Act. Affinity Behavioral Health LLC (“Affinity”) is co-owned by Julie Longton, a licensed marital and family therapist, and her daughter, Leanda Zupka, a licensed clinical social worker. Affinity, Longton and Zupka are enrolled as behavioral health providers in the Connecticut Medical Assistance Program (CMAP), which includes the state’s Medicaid program. The state alleged that, from April 2013 to December 2016, Affinity, Longton and Zupka knowingly submitted claims to the CMAP for payment for behavioral health services purportedly performed by licensed behavioral health clinicians when, in fact, the services were rendered by unlicensed individuals employed by Longton and Zupka. CT

July 10, 2018

Maryland announced that Rebecca D. Norris pleaded guilty to one count of felony Medicaid fraud for masterminding a series of fraudulent schemes at two western Maryland clinics she owned, resulting in a $825,000 loss to the Maryland Medicaid program. Norris’s sister, Heidi M. Wiley, 32, also pleaded guilty to one count of Felony Medicaid Fraud for her role as a biller in Norris’ schemes. Norris used a series of financial incentives to induce Wiley and other unindicted co-conspirators to assist her in these fraudulent schemes, including paying commissions for billing services to Medicaid. She also directed her staff to conceal the fraud during a visit from state auditors by altering and doctoring patient records. MD

July 5, 2018

North Carolina announced it has settled with Rotech Healthcare Inc., a Florida-based respiratory equipment supplier, over civil allegations that Rotech knowingly submitted false claims for portable oxygen contents to Medicaid and Medicare. The settlement is joined by 22 other states and the federal government. The total settlement is $9.95 million, of which North Carolina will receive $43,671.23. Between 2009 and 2012, Rotech automatically billed Medicaid and Medicare for portable oxygen contents regardless of whether the beneficiaries used or needed portable oxygen and without obtaining the required proof of delivery. Rotech continued this practice despite knowing that it was submitting ineligible claims. NC  The settlement is part of previously-reported settlement with the federal government and other states.  April 12 Federal Settlement. The case was initiated by a whistleblower.