Michigan’s Attorney General (AG) recently announced the filing of 20 felony counts of Medicaid Fraud against the owner of a counseling treatment center. The charges resulted from an investigation that revealed a former employee of the center provided counseling services to patients in the facility without being licensed to do so.
The AG’s investigation discovered that the owner of the facility was aware that the employee was not licensed but still allowed her to counsel the centers’ patients. The owner billed Medicaid for those services under his provider identification number.
The owner turned himself in to the authorities, was arraigned in a district court, and given a $20,000 personal recognizance bond. He is scheduled to appear for his probable cause hearing on January 17.
If found guilty, the owner faces a possible four-year imprisonment for Medicaid Fraud.
Compliance Perspective
Issue
Knowingly allowing unlicensed persons to provide counseling services and knowingly submit bills to Medicaid for reimbursement of those services may be considered fraud under the False Claims Act, in violation of state and federal regulations.
Discussion Points
- Review policies and procedures regarding ensuring that employees hired to perform services requiring licensure have been verified before starting work.
- Train appropriate staff to follow protocols for verification of licenses and certifications of employees hired and on an ongoing basis to ensure that those licenses remain up-to-date and are unencumbered. Licensed staff should also be trained about their responsibility to notify the employer of any encumbrances or suspensions to their license and that failure to do so may cause them to be disqualified from working for Medicare and Medicaid providers.
- Periodically audit to ensure that licensed staff have up-to-date verifications of their licenses.
FOR MORE INFORMATION ON THIS TOPIC: STAYING ON TOP OF EMPLOYEE CHECKS.
