The former owner, office manager, and business manager of a Missouri-based home healthcare company pleaded guilty to a federal charge on May 13, 2024. The three women admitted involvement in a healthcare fraud conspiracy that fraudulently billed the Missouri Medicaid program more than $552,000.
They each admitted that from roughly January 2018 to August 2021, they conspired to submit fraudulent reimbursement claims to Missouri’s Medicaid program for personal care services that were never provided. They admitted receiving $552,659.
The three women submitted fraudulent claims for personal care services purportedly provided for a woman who did not live in Missouri and received no services, their plea agreements say. They also submitted claims for providing services for clients at times when their own social media posts showed them doing something else.
In a separate civil settlement, the three agreed to pay $910,000 to resolve allegations that they violated the False Claims Act by billing Missouri Medicaid using false timesheets and payroll records for in home services that were never provided.
The three are scheduled to be sentenced August 26. The charge is punishable by up to 10 years in prison, a $250,000 fine, or both prison and a fine.
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.*
