A Suffolk woman pled guilty to one count of healthcare fraud and six counts of making false statements relating to healthcare matters. According to court documents, from June 2016 through October 2018, Whitteney Guyton, 43, engaged in a scheme to defraud the Virginia Department of Medical Assistance Services (DMAS), which administers Medicaid in the Commonwealth. Guyton owned and operated Synergy Health Systems LLC (Synergy), Which provided healthcare services to patients covered by Medicaid. Ms. Guyton billed Medicaid for the services she claimed Synergy provided to patients. However, the company’s records were falsified, incomplete, failed to comply with basic Medicaid requirements, and included inflated time. Synergy offered two types of care: personal and respite care, and mental health skill building (MHSS). The services that Synergy offered required assessments by licensed professionals to comply with Medicaid regulations. To be paid for personal care, a registered nurse (RN) must complete the patient assessment. A licensed mental health professional (LMHP), such as a licensed clinical social worker (LCSW) is required to fill out assessments for, and periodically re-assess, patients receiving mental health services.
While Guyton had an LCSW contractor from 2016 to July 2017, she did not have another LMHP to do the assessments or reassessments until October 2018. Guyton instructed her staff to forge the original LCSW’s signature on assessments and certifications. Guyton and Synergy submitted documents to DMAS for authorization for MHSS for over 35 patients that contained forged signatures and authorizations, fraudulently billing and receiving over $740,000 from DMAS. Guyton and Synergy did the same for personal care and respite services. Guyton and Synergy forged signatures of an RN and fraudulently billed and received over $50,000 from DMAS. Synergy billed and received from DMAS an additional $480,000 for patients for whom there was no documentation that any assessment had ever been done or while they were in the hospital or at other care settings. Guyton and Synergy also inflated the time for billing for mental health services. As a result of these schemes, Guyton illegally obtained approximately $1,320,088.
