Healthcare Compliance Perspective:
An effective Compliance and Ethics Program must focus on verifying the authenticity and sufficiency of departmental checks and balances.
Michigan’s State Attorney General has charged a former nursing home biller in Michigan with embezzling payments received from the nursing home’s residents, and attempting to hide what she was doing by issuing more than $600,000 in fraudulent Medicaid billings.
The 40-year-old woman is accused of committing the alleged crimes over a period of five years from 2011 to 2016. Additionally, the woman has also been charged with cocaine possession at the time of her recent arrest.
After the police received a complaint from the nursing home, they suspected that fraud might be involved; so, they notified the Attorney General’s Office. Consequently, the woman will be arraigned in court next week on a total of 12 charges.
The nursing home has alleged that cash payments from or on behalf of the residents were not entered into the facility’s accounting system and deposited appropriately. Investigators, in their follow-up investigation, found evidence that the accused former biller allegedly kept the money; then, fraudulently billed Medicaid for more than $600,000 to cover-up the misappropriated payments and forestall being detected earlier.
The accused woman faces “six counts of Medicaid fraud, three counts of false pretenses, one count of embezzling from a vulnerable adult, one count of continuing a criminal enterprise and one count of cocaine possession.” The maximum penalty connected to the charges totals 32 years.
