New York Medical Transportation Company Pleads Guilty
to
Health Care Fraud and Paying Kickbacks
Conspiring to defraud Medicaid by submitting claims for services not provided is fraud and a violation of the False Claims
Compliance Perspective – Medicaid Fraud
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review policies and procedures involving vendor contracts.
Training: The Compliance and Ethics Officer with the Administrator will ensure that staff involved in the contract process are trained regarding the investigation and screening protocols and the documents and information to be provided by the vendor.
Audit: The Compliance and Ethics Officer should personally conduct a periodic audit to ensure that vendors providing services to the facility have not been excluded or sanctioned due to Medicare and Medicaid related program violations and are not on the OIG list of excluded individuals and entities or debarred contractors.
The owner of a New York medical transportation company recently pled guilty to conspiring to defraud Medicaid and conspiring to pay bribes and kickbacks to Medicaid beneficiaries using his medical transportation service. The defendant admitted causing at least $550,000 in losses and paying at least $95,000 in bribes and kickbacks.
The investigation revealed that the New York State Department of Health (DOH) paid the defendant’s company at least $2.45 million for Medicaid-funded transportation between 2014 and 2018.
Admitting to the committing of several variations of fraud against Medicaid and the DOH was part of the defendant’s plea agreement. He also admitted to billing Medicaid and receiving payment for trips where beneficiaries drove themselves to their own medical appointments, falsifying the identities of the drivers for those trips, billing Medicaid, receiving payment for roundtrips to and from medical appointments that were only one-way trips, and falsifying pick-up and drop-off locations in order to inflate the claimed distances traveled, which enabled him to receive higher Medicaid reimbursements.
The defendant further admitted paying kickbacks and bribes to Medicaid beneficiaries to get them to schedule and keep re-scheduling medical transportation appointments. The kickbacks included cash, cigarettes, tobacco, and other free items from a convenience store owned by the defendant.
Along with a possible 10-year prison term, the defendant may be required to pay a fine of up to $250,000 and up to 3 years of supervised release. Sentencing is set for June 18, 2019.
In a parallel case pending in Essex County Court, the defendant agreed to pay restitution of $550,000 to the New York State Department of Health and to plead guilty to charges of grand larceny and failure to secure workers’ compensation.
