Compliance Perspective – Defrauding Medicaid:
The Compliance Officer should review the facility’s policies and procedures with the Administrator and the Compliance Committee regarding vendor contracts and the required background investigation (i.e., review of the OIG’s List of Excluded Individuals) and including the completion of the vendor’s application prior to the execution of a vendor contract. Staff involved in the contract process need to be trained regarding the investigation process and the documents and information to be provided by the vendor. The Compliance Officer is responsible to ensure that an audit is performed on a regular basis to determine if any vendors providing services to the facility have been excluded or sanctioned regarding Medicare and Medicaid or other entities.
The owner of a company, Waveney Blackman of Bowie Maryland, that provided durable medical equipment pleaded guilty recently to a federal charge of healthcare fraud for carrying out a scheme in which the owner fraudulently obtained more than $9.4 million in District of Columbia Medicaid payments.
Blackman was the sole owner and chief executive officer of a healthcare service company, based in the District of Columbia, that provided durable medical equipment, including wound care and incontinence supplies, to Medicaid beneficiaries and others. The company became a Medicaid provider in 2008.
According to the plea documents, Blackman devised and executed a scheme to submit false and fraudulent claims to Medicaid for durable medical equipment, including incontinence and wound care supplies, knowing that the i
tems were not purchased or provided to Medicaid beneficiaries. From January 2010 through approximately June 2016, Blackman sent and caused employees to send false and fraudulent invoices to a biller engaged by the company, which were then submitted to Medicaid. The total amount of false claims submitted to Medicaid was at least $9.8 million.
The charges filed were part of the nation’s largest ever health care fraud enforcement action. The various enforcement actions involved 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in healthcare fraud schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
According to the plea documents, Blackman used the fraudulent proceeds to obtain properties, including three in Florida and four in Maryland, as well as a Mercedes Benz.
The defendant’s sentencing is scheduled for Oct. 18.
