Medicaid

February 25, 2017

New York announced the arrest of Kester Atumonyogo, 43, of Valley Stream, N.Y., and his company Monack Medical Supply, Inc. (“Monack”) for allegedly stealing over $1.5 million from Medicaid and Healthfirst, a Medicaid managed care organization. The defendants are accused of using a false Social Security number to enroll Monack as a participating medical supply provider in Medicaid. Thereafter, the company allegedly filed false claims that misrepresented to Medicaid and Healthfirst that Monack dispensed a highly specialized, expensive enteral, nutritional formula to needy pediatric patients. Enteral nutritional formulas are prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. The Medicaid reimbursement rate for specialized enteral, nutritional formula is substantially higher than off-the-shelf or over-the-counter nutritional supplements. The Attorney General’s investigation conducted by the Medicaid Fraud Control Unit (MFCU) revealed that Medicaid and Healthfirst, relying on Monack’s false claims, paid Monack for specialized enteral, nutritional formula, but that Monack only dispensed “Pediasure” or similar over-the-counter nutritional supplements to Medicaid patients, when it dispensed anything at all. NY

February 17, 2017

A Wellesley-based dental provider and its billing agent have agreed to pay $1.5 million to Massachusetts’ Medicaid program (MassHealth) to resolve allegations of improper billing for visits to MassHealth members living in nursing homes. The settlement resolves allegations that dental provider Alec H. Jaret, DMD, PC d/b/a HealthDrive Dental Group and its billing agent, HealthDrive Corporation, overbilled MassHealth for nursing home visits. The AG’s Office filed a complaint against the defendants in March 2014 alleging that between July 2010 and September 2013, HealthDrive, on behalf of HealthDrive Dental Group, overbilled MassHealth for nursing home visits by charging a separate “house call” fee for multiple patients treated at the same facility on the same day. An investigation by the AG’s Office revealed that HealthDrive was paid for more than 34,700 excessive claims on a per-patient per-day basis, contrary to MassHealth’s regulations on dental house calls established in 2010. The parties have reached a civil settlement agreement pursuant to which HealthDrive and HealthDrive Dental Group will pay MassHealth $1,500,756 to resolve all claims. MA

February 1, 2017

Iowa nursing facility the Abbey of Le Mars, Inc., and other individuals with financial interests in the Abbey’s operations, agreed to pay $100,000 to settle allegations they violated the False Claims Act by submitting or causing claims to be submitted to Medicaid when the care provided to nursing facility residents was so grossly substandard it was worthless and effectively without value.  DOJ (NDIA)

January 27, 2017

Brooklyn residents Olga Proskurovsky, Yuriy Omelchenko and Isak Aharanov pleaded guilty in connection with a health care fraud scheme involving two Brooklyn clinics that caused approximately $55 million in false claims to Medicare and Medicaid.  They agreed to forfeiture money judgments in the amount of roughly $17 million.  Proskurovsky served as a medical biller and Omelchenko worked as a therapist manager at Prime Care on the Bay LLC and Bensonhurst Mega Medical Care P.C. where they assisted in a scheme to defraud the Medicare and Medicaid programs in which patients subjected themselves to medically unnecessary health services, including physical and occupational therapy, provided by unlicensed staff.  DOJ

January 12, 2017

Idia Oriakhi, the administrator of five Houston-area home health agencies, pleaded guilty to conspiring to defraud the State of Texas’ Medicaid-funded Home and Community-Based Service and the Primary Home Care Programs of more than $7.8 million. Oriakhi’s parents owned and operated Aabraham Blessings, LLC; Baptist Home Care Providers, Inc.; Community Wide Home Health, Inc.; Four Seasons Home Healthcare, Inc. and Kis Med Concepts, Inc. and admitted that she, her father Godwin Oriakhi and others obtained patients for her family’s home health agencies by paying illegal kickback payments to patient recruiters and physicians for referring and certifying Medicaid patients for services not medically necessary and often not provided. DOJ

January 12, 2017

Connecticut home healthcare provider Family Care Visiting Nurse and Home Care Agency, LLC and its owners David A. Krett and Rita C. Krett agreed to pay roughly $5.25 million to resolve allegations they violated the False Claims Act by billing for services which under Medicaid required a registered nurse when in fact a registered nurse did not provide the services. The government further alleged the company submitted claims to Medicaid for patients who were or may have been dually eligible for Medicare and Medicaid without first following required procedures for submitting claims to Medicare. DOJ (DCT)

January 12, 2017

The Confederated Tribes of the Colville Reservation (CGT) agreed to pay roughly $246,000 to settle charges it violated the False Claims Act by submitting false claims to Medicaid seeking the reimbursement of mental health counseling services either not provided or not medically indicated or necessary. The CCT is a federally recognized, sovereign Indian tribe, with tribal offices located at Nespelem, Washington, on the Tribes’ reservation. DOJ (EDWA)