On December 7, 2021, a New Hampshire woman was arrested and charged with theft by deception, false claims, and presenting false records concerning allegations that she submitted Medicaid claims for mileage reimbursement in connection with medical appointments that never occurred.
It is alleged that between August 22, 2019, and February 28, 2020, the New Hampshire woman gave falsified reimbursement claims to New Hampshire Medicaid’s non-emergency medical transportation broker so that she could receive mileage reimbursement for traveling to medical appointments within New Hampshire. The medical appointments did not exist. Additionally, it is alleged that the New Hampshire woman acted with intent to defraud New Hampshire Medicaid, and also received over $1,500 in Medicaid funds in connection with the alleged scheme.
The maximum penalty on the Theft by Deception charge, a class A felony, is 7½ to 15 years in the New Hampshire State Prison. The maximum penalty for the False Claims and Presenting False Records charges, both class B felonies, is 3½ to 7 years for each in the New Hampshire State Prison.
The charges and allegations are merely accusations, and the New Hampshire woman is presumed innocent unless and until proven guilty. She will be arraigned on January 6, 2022.
Compliance Perspective
Issue
Most states provide reimbursement for mileage expenses for non-emergency medical transportation of Medicaid recipients. Although each state differs in how reimbursement is recouped, it is vital that the guidelines and regulations are followed correctly for reimbursement of non-emergency medical transportation. If reimbursement requests are submitted to Medicaid for non-emergency transportation that did not occur or was not medically necessary, it can be seen as a false claim. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions. 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 mileage reimbursement, including your policy and procedures for non-emergency medical transportation for Medicaid recipients. Update as needed.
- Train all appropriate staff on your mileage reimbursement policy and procedure and ensure that staff are aware of what can be considered a false claim. Document that the trainings occurred and place in each employee’s education file.
- Periodically audit mileage reimbursement claims to determine if your procedure was followed for submission for reimbursement. Additionally, audit any mileage reimbursement claims to Medicaid for non-emergency medical transportation to ensure that the transportation was medically necessary and was provided.
