On November 12, 2021, the South Carolina Attorney General announced the arrest of a 37-year-old South Carolina woman for two counts of Obtaining Signatures or Property by False Pretenses of $10,000 or more, which is a felony with a penalty of up to ten years in prison. The woman was booked into the County detention center on November 10th.
An investigation by the South Carolina Medicaid Fraud Control Unit (SCMFCU) alleges that between July 30, 2018, and March 26, 2021, the woman was employed by a South Carolina County Disabilities and Special Needs Board. While serving as a member of the board of directors, the woman submitted time sheets for services she did not provide, which resulted in the improper submission and payment of claims by the South Carolina Medicaid Program for the falsely reported services. An exact figure of the amount of the fraud has not yet been determined.
Pursuant to federal regulations, the SCMFCU has authority over Medicaid provider fraud; abuse and neglect of Medicaid beneficiaries in any setting; and the abuse, neglect, and exploitation of individuals residing in assisted living facilities or nursing homes.
Compliance Perspective
Issue
Obtaining a signature or property by false pretense is a felony act. A signature obtained by false pretense occurs when a signature was obtained under false representation of a past or existing fact, and the representative obtaining the signature had an intent to defraud. An effective Compliance and Ethics Program is key in preventing and auditing for fraudulent behavior among employees and agents, including the governing body. Additional information is available in the Med-Net Corporate Compliance and Ethics Manual, Chapter 1, Compliance and Ethics Program, CP 2.3 General Legal Duties and Antitrust Laws.
Discussion Points
- Review policies and procedures for preventing and reporting a false claim. Update as needed to ensure they are current.
- Train all staff that intentionally submitting false information which results in submission of a false claim can be considered fraud. Provide training on the False Claims Act and what comprises a false claim. Include information on how to report concerns and suspected violations, and that prompt reporting is mandatory. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit staff understanding to ensure that they are aware of the necessity of only creating accurate and factual documentation. Also ensure they understand what should be done if they suspect a false record or false claim has occurred. Conduct audits of documentation and billing practices routinely to prevent and detect errors before they progress to a false claim.
