A behavior analyst who was employed by a Florida home health agency has been arrested for Medicaid fraud. The man provided behavior analyst services for three Medicaid recipients, all of whom had disabilities. Two of the recipients were children.
The parent of one of the children noticed incorrect information on a Medicaid online portal and reported it. The bills there showed services that had never been provided to her son. This prompted an investigation by Florida’s Medicaid Fraud Control Unit (MFCU), which found that the behavior analyst had cheated three victims out of services by billing the Medicaid program for sixteen alleged visits over a four-month period.
The behavior analyst is accused of stealing nearly $12,000 from the Florida Medicaid program, and faces one count of Medicaid provider fraud, organized fraud, and grand theft. All three of these charges are third-degree felonies and punishable up to a term of five years.
Florida’s Attorney General Ashley Moody stated, “Falsifying timesheets to receive thousands of dollars from Medicaid jeopardizes the integrity of the healthcare program and ultimately harms taxpayers. I’m proud of my Medicaid Fraud Control Unit for stopping this fraudulent scheme and ensuring the suspect charged with stealing thousands of taxpayer dollars faces justice.”
Issue:
Billing Medicare or Medicaid for services that were not provided is fraudulent activity that is often punishable by fines and imprisonment. Ensure that staff understand that claims should be as accurate and complete as possible, medically necessary, and reviewed carefully before submitted to Medicare or Medicaid.
Discussion Points:
- Review your policies and procedures for accurate billing and provision of services. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train appropriate staff on how to determine each resident’s level of care and if services provided are reasonable and necessary. Document that these trainings occurred, and file the signed documents in each employee’s education file.
- Periodically perform audits on claims submitted to Medicare and Medicaid to ensure that the services being billed are necessary, accurate, and that there are no inconsistencies. Staff should be aware of compliance and ethics concerns and understand their responsibility to report any violations to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
