Medicaid

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.

June 25, 2018

New York announced registered nurse Collins Anyanwu-Mueller has been sentenced to a year in prison for stealing over $390,000 from Medicaid. A MFCU investigation uncovered that Anyanwu-Mueller submitted false Medicaid claims for private duty nursing services that he never provided to two severely disabled Medicaid recipients. Both Medicaid recipients required around-the-clock care. Prior to sentencing, Anyanwu-Mueller paid the State of New York $25,000 and has agreed to pay the remaining $367,954 in restitution owed. NY

May 29, 2018

Wal-Mart and Sam’s Club will collectively pay $825,000 to resolve federal and state False Claims Act allegations the company’s automatic prescription refills for Minnesota Medicaid patients violated Minnesota law and wasted taxpayer dollars on unnecessary and unused medications. USAO DMN

May 16, 2018

Stephanie L. Patterson was sentenced to five years of probation and ordered to pay more than $81,000 for falsely claiming payments from the State of Illinois Medicaid Home Services Program for hundreds of hours of home health services not performed. USAO SDIL

April 27, 2018

New Era Rehabilitation Center and its owners agreed to pay roughly $1.4 million to resolve allegations they violated the False Claims Act by improperly billing Medicaid for methadone maintenance counseling services and psychotherapy services for the same patients. DOJ (CT)