The New Hampshire Attorney General announced that a caregiver, age 43, of Andover, Massachusetts, has been convicted of class B felony Medicaid Fraud – False Claims and class B felony Medicaid Fraud – False Records.
On August 1, 2024, the defendant pleaded guilty to stealing $7,249.75 in Medicaid funds by submitting false documentation to two separate home healthcare companies in which she claimed that she had provided care to a Medicaid member within their home. The false documentation included timesheets on which the defendant recorded that she provided home care on dates and at times that she was not at the Medicaid member’s home to provide the care that she documented.
The defendant was sentenced to serve 12 months at the Merrimack County House of Corrections on the Medicaid Fraud – False Claims charge. All but 45 days of that sentence is suspended for five years upon her release from the House of Corrections on the condition that she remain of good behavior and comply with the terms of her sentence. She was also sentenced to serve an additional 1 to 2 years in the New Hampshire State Prison on the Medicaid Fraud – False Records charge. This sentence is fully suspended for five years upon her release.
As a condition of the sentences, the defendant will also be required to complete 100 hours of community service upon release and will not be permitted to seek employment with vulnerable citizens. She paid the full $7,249.75 in restitution at the time of her sentencing.
Compliance Perspective
Issue
Honesty, accuracy, and integrity are imperative for the provision of safe and effective healthcare. Falsification of documents regarding care, incomplete or inaccurate documentation of care, failure to provide the care documented, or other acts of deception or omission raise serious concerns about an individual’s ability to provide safe healthcare. Falsified documentation and misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care.
Discussion Points
- Review your policies and procedures for following standards of care and requirements for accurate documentation. Also review your policies and procedures for operating an effective compliance and ethics program. Update as needed.
- Train appropriate staff on your policies and procedures for following standards of care, accurate documentation, and meeting regulatory requirements. Also train all staff on your compliance and ethics policies and procedures upon hire and at least annually, including their responsibility to identify and report any concerns of fraud, waste, or abuse of government funds in a timely manner.
- Periodically audit medical records and timesheets to ensure that documentation is complete, meets standards for content and timeliness, and that entries have not been falsified or erroneously reported in any way.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
