A US attorney recently announced the guilty plea received from the owner of a taxi and limousine company for conspiring to defraud Medicaid. The accused man admitted to committing several frauds from 2015 to 2018 against Medicaid and the New York State Department of Health (NYSDOH). The frauds involved billing Medicaid and receiving payment for trips in which beneficiaries transported themselves to their medical appointments, falsifying the identities of the drivers for those trips, and billing Medicaid and receiving payment for round trips to and from medical appointments when the trips involved only one-way transportation.
The accused is the last of six defendants to plead guilty to federal charges in connection with the Medicaid fraud case that involved the owners and operators of several medical transportation companies within the same county.
The defendant agreed to pay $200,000 in restitution and faces up to 10 years in prison, a fine of up to $250,000, and up to three years of post-imprisonment supervised release. His sentencing is scheduled for June 9, 2020.
Compliance Perspective
Failure by a nursing home to screen vendors, such as transportation companies that will transport the facility’s residents to appointments, to determine if they have been excluded as a provider may violate state and federal regulations, causing a nursing home to be excluded as a Medicare/Medicaid provider.
Discussion Points
- Review policies and procedures for screening vendors to ensure they have not been excluded as a Medicare/Medicaid service provider.
- Train staff involved in the selection and use of vendors to check the databases for excluded individuals and debarred contractors to ensure that the vendors have not been excluded as providers.
- Periodically audit vendors/contractors used by the facility to provide services to residents who are Medicare/Medicaid beneficiaries to determine if they are being screened for exclusion from Medicare and Medicare prior to being used.
FOR MORE INFORMATION ON THIS TOPIC: FRAUD MODULE 10 – VENDOR CONTRACTS AND STAYING ON TOP OF EMPLOYEE CHECKS
