Home Health & Hospice Week

Plus: New York provider shells out $10 million to settle fraud charges.

More Medicaid home care fraud cases show why this is an increasing area of scrutiny across the nation.

For example, authorities in Florida have arrested the owner of a home health agency and a parent of a disabled child for Medicaid provider fraud, says the state Medicaid Fraud Control Unit in a release. Latrena Marie Thomas, owner of A River’s Journey with facilities in Yulee and Jacksonville, is accused of hiring non-licensed individuals to provide hands-on personal care services to Medicaid recipients and paying Donald Ray Adams II, a parent of a disabled Medicaid recipient, to provide medically licensed care for his own child, the MFCU says.

In addition to hiring non-licensed staff who couldn’t pass background screenings, Thomas failed to have a Director of Nursing on staff to provide oversight of the licensed practical nurses and other staff, and falsified the agency’s employee roster, progress notes, service logs and plan-of-care documents. “Thomas’s negligent assignment of unqualified staff to recipients created three separate medical emergencies, including a trach tube dislodging, extreme sunburn and a delay in contacting Emergency Medical Services,” the MFCU charges.

Thomas also billed for a recipient’s 24/7 nursing care while paying Adams, and paid him for providing unsigned progress notes for his own child’s care, the MCFU says. “Adams received payments in cash, gift cards and bank deposits from the agency,” it says.

“This fraudulent billing scheme not only defrauded the Florida Medicaid program out of more than $1.6 million but did so at the expense of Medicaid-dependent recipients, one being a disabled child,” Florida Attorney General Ashley Moody says in the release. “In addition to manipulating the system for extra money, the hiring of unqualified and unlicensed medical staff resulted in poor treatment and medical emergencies for Medicaid patients. I’m grateful for our Medicaid Fraud Control Unit for putting a stop to this scheme,” Moody says.

Other recent cases include:

In New York: RiverSpring at Home (ElderServe) has paid $10.1 million to settle charges that it failed to provide seniors with “personalized health care services,” but billed the state for them anyway. “For years, RiverSpring and ElderServe collected millions of dollars in Medicaid payments while members of the RiverSpring Managed Long Term Care Plan in New York City and Westchester, Nassau, and Suffolk counties did not receive the care they were promised,” says a release from Attorney General Letitia James. RiverSpring is a dba of RiverSpring Living Holding Corp. and ElderServe Health Inc. — both nonprofits. A former employee initiated the case as a qui tam relator and will receive a portion of the settlement, the state notes.

In Michigan: Julia Bland has been arraigned on a Medicaid fraud charge, says Michigan AG Dana Nessel in a release. Thanks to a smart phone app used to submit claims, authorities discovered that Bland allegedly submitted claims for services when she was not in the area of the benefi­ciary’s home, as reflected in timesheets filed with agency GT Independence. “Caregivers who use the program to commit fraud will be held accountable,” Nessel warns in the release.