By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
On April 19, 2016, three individuals from Central Florida were arrested and charged in a Medicaid fraud case using the stolen identities of students and false mental-health evaluations, according to the Florida Attorney General’s Office. The three allegedly assisted Orlando-based companies to defraud Medicaid out of more than $500,000 for services that were never rendered. The companies that were fraudulently billed were Revive Athletics, Divine Consulting and Durden Consulting, according to the Attorney General’s Office.
The Details of the Scheme.
One of the arrested was the head of an Orange County Schools mentoring program, Young Men of Promise. According to officials, he allegedly took and sold students’ identities and also fraudulently diagnosed students with mental health issues to illegally bill Medicaid. According to the report, he does not hold any licenses with the Florida Department of Health and isn’t authorized to diagnose mental-health disorders. He faces charges of Medicaid fraud, criminal use of personal information and organized scheme to defraud.
The other two individuals reportedly worked as case-management supervisors with the consulting company and would bill Medicaid for services the students never received, according to the arrest report. They each face one count of organized scheme to defraud. Only one individual has been arrested, the other is still at large.
To read the press release on this case from the state attorney general, click here.
Fake Mental-Health Evaluations.
The Young Men of Promise program usually consisted of between 15 and 22 students and met at an Orange County Florida high school. Investigators spoke with one student who was part of the mentoring program and detected “suspicious billing” on his Medicaid account, up to $6,000. He claimed that group meetings were not counseling sessions; he had no idea why his Medicaid account would have been billed for that amount. He was also reported as stating he was “upset to learn that he has a mental diagnosis.” He intends to have this removed from his record.
Authorities called the scheme “sophisticated,” saying many children are low labeled with mental-health disorders they don’t have and the suspects “only desired to financially benefit from tax dollars they were not entitled to.”
Click here to read one of my prior blogs on Medicaid fraud.
Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Sources:
Allen, Stephanie. “False mental-health evals part of Medicaid scam, officials say.” Orlando Sentinel. (April 21, 2016). Web.
Harris, David. “Three charged in Medicaid fraud scheme involving student identities.” Orlando Sentinel. (April 19, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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