Home Health & Hospice Week

Medicaid fraud-plus-wage fraud seen in more than one case.

State authorities are putting more focus than ever on home care fraud, recent cases show.

For example: In Georgia, the “Medicaid Fraud Division has obtained civil recoveries totaling more than $68 million since November 2016,” state Attorney General Chris Carr crowed in an April 6 release. “Over this same time period, the Attorney General’s Medicaid Fraud Division has prosecuted more than 60 people for Medicaid fraud and the abuse, neglect and exploitation of older adults, resulting in $17 million in restitution orders in criminal matters,” according to the statement.

Under Carr’s tenure, “the Medicaid Fraud Division has emphasized investigations involving the abuse, neglect and exploitation of Georgia’s older and at-risk adults,” the AG’s office says. Among the cases listed are the guilty plea from Helping Hearts Hospice CEO and owner Nourolzaman Tucker. Tucker admitted to billing for services she supposedly provided when she was out of the country and for overlapping billing times. She was sentenced to five years probation, ordered to pay restitution totaling $5,681.86, fined $5,000, and excluded from participation in both Medicaid and Medicare, according to the release.

Other recent Medicaid cases include:

In New York: Two Medicaid home health agencies will repay $5.4 million to the Medicaid program after admitting to submitting false claims, New York Attorney General Letitia James says in a release. All American Homecare Agency Inc. has ponied up $4 million and Crown of Life Care NY will repay $1.4 million. “These companies shamelessly … cheated our state and stole from communities that need it most. My office will never tolerate fraud of any kind,” James said. Crown will also pay $1.5 million to workers whom it underpaid, according to James.

In Tennessee: Authorities have arrested home care provider Gena R. Kilgore, according to a release from the Tennessee Bureau of Investigation. Between July 2017 and March 2020, Kilgore enrolled a family member to receive home healthcare services from her employer, submitted timesheets on behalf of other caregivers for the family member’s care, and collected payments for services that were not provided by the caregivers, TBI alleges. Also in the state, authorities arrested nurse Keasha Liggins and home health worker Latyona Smith for submitting time sheets for home care services they never provided, according to the TBI.

In Massachusetts: Medicaid home health agency Com­passionate Homecare Inc. has agreed to pay $6.53 million to MassHealth to resolve allegations that it billed the Medicaid program for services that were not authorized by a physician, state Attorney General Maura Healey says in a release. In addition, up to $375,000 will be set aside for payment of unpaid wages for former Compassionate employees. In Sep­tember 2019, Compassionate and its owner, Francis Kimaru, pleaded guilty to separate criminal charges brought by the AG’s Medicaid Fraud Division. As part of that plea, Compassionate and Kimaru admitted to stealing hundreds of thousands of dollars from MassHealth by routinely overbilling and falsely billing for services that were not authorized or provided to patients. Compassionate filed for bankruptcy in May 2020.

Also in Massachusetts: A jury has indicted Richard Blake III, Frank Berry Jr., and Berry’s parents Frank Berry Sr. and Patricia Berry for a MassHealth scheme in which Berry Jr. and Blake submitted false personal care services time sheets for times when they were working other jobs, according to Healey.

In Nevada: State Attorney General Aaron D. Ford praises the state’s Medicaid Fraud Control Unit, noting the MFCU undertook 318 investigations in 2021, resulting in 21 charges, 19 convictions and 13 civil settlements, according to a recent release. “The Unit brought in around $3.35 million during 2021, a recovery of almost $197,000 per staff member, meaning the MFCU brought in much more money to Nevada than the $2.53 million in expenditures it cost the state,” Ford noted in the release. “The MFCU also continued its outreach efforts to educate Medicaid providers, the elderly and Nevada citizens about the role of the MFCU in the community,” he added.

In Florida: Authorities arrested CNA Leita Tanis Apollon on charges of defrauding the Florida Medicaid program out of more than $38,000 by submitting fraudulent personal care claims. Apollon submitted the false claims while an unqualified person actually provided the services, according to state Attorney General Ashley Moody.