medicaid audit | The Health Law Firm Blog

Florida Medicaid Audits Dental Claims

By Michael L. Smith, R.R.T., J.D., Board Certified by The Florida Bar in Health Law

The Agency for Health Care Administration (AHCA) is auditing Medicaid claims submitted by dental providers in Florida. AHCA is auditing dental practices looking for claims that were not billed in compliance with the Florida Medicaid Dental Services Coverage and Limitations Handbook. AHCA’s audits are focused on claims that are billed too frequently, claims that are billed on the same date of service as a redundant code, and claims that have been unbundled when they should have been billed as part of a comprehensive code.

Specific Dental Codes Being Audited.

Dental providers that are the subject of these audits may not learn of the audit until they receive the Preliminary Audit Report. It is extremely important to immediately retain experienced health care counsel if you receive a Preliminary Audit Report […]

Director of Center for Developmentally Challenged Adults Accused of Medicaid Fraud

By George F. Indest III J.D., LL.M., Board Certified by The Florida Bar in Health Law

The director of a center for developmentally challenged adults in Okaloosa County, Florida, was arrested on August 16, 2012, for allegedly fraudulently billing Medicaid for more than $270,000 for services under the Medicaid Developmentally Disabled Waiver Program, according to the Attorney General’s (AG) office.

To read the entire press release from the AG’s office, click here.

Director Allegedly Submitted False Claims for Non-Billable Services and Falsified Hours.

According to the press release, in 2009, the Medicaid Fraud Control Unit (MFCU) began investigating the center after it received a referral from the Agency for Persons with Disabilities (APD). The director allegedly submitted claims seeking $270,000 in reimbursements for non-billable services and falsified hours to the Medicaid program.

Director […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Categories: Medicare Fraud, Mental Health Counselor, Mental Health Counselor Law|Tags: defense attorney, legal defense, medicaid, medicaid audit, Medicaid defense attorney, Medicaid fraud, Medicaid Fraud Control Unit (MFCU), Medicaid fraud defense attorney, MFCU investigation, mfcu subpoena|Comments Off

Woman Admits to Defrauding Medicaid For Fake Mental and Behavior Health Services

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A North Carolina woman pleaded guilty on September 14, 2012, for her involvement in a health care scheme that allegedly defrauded Medicaid from 2008 to 2011 for fake mental and behavior health services. Through this scheme, she allegedly obtained at least $6.1 million in fraudulent reimbursement payments, according to the Federal Bureau of Investigation (FBI).

Click here to see the press release from the FBI.

Medicaid Beneficiaries Were Primarily Children.

An article in the Gaston Gazette stated the former licensed professional counselor, who was enrolled with North Carolina Medicaid, allegedly claimed in the fraudulent billings that she was the attending clinician for provided services. The woman also allegedly supervised a network of co-conspirators who billed […]

By The Health Law Firm|2024-03-14T10:01:49-04:00May 15, 2018|Categories: Clinical Social Worker, Intern, Marital and Family Therapist, Medicaid audit, Mental Health Counselor, Mental Health Counselor Law, Psychology, Resident|Tags: defense attorney, Florida defense attorney, legal defense, medicaid, medicaid audit, Medicaid defense attorney, Medicaid fraud, Medicaid fraud defense attorney, Medicaid scheme, North Carolina defense attorney|1 Comment

Central Florida Mental Health Counselor Accused of Heading Up $3 Million Medicaid Fraud Scheme

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law, and Michael L. Smith, J.D., R.R.T., Board Certified by The Florida Bar in Health Law

A registered mental-health counselor is accused of running a $3 million Medicaid scheme through the mental health facility she owned, according to the Florida Office of the Attorney General (AG). On March 27, 2013, the facility owner was arrested. She faces charges of racketeering, Medicaid fraud and identity theft. According to the AG, local, state and federal law enforcement officers were all involved in the investigation.

Click here to read the press release from the AG.

Mental Health Counselor Reportedly Billed Medicaid for Services Never Rendered.

According to the Orlando Sentinel, between 2012 and 2013, the mental health counselor billed Medicaid more than $3 million for services provided to Medicaid recipients with […]

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Medicaid audit, Mental Health Counselor, Mental Health Counselor Law|Tags: attorney general’s (AG) office, defense attorney, defense lawyer, Florida defense attorney, Florida Medicaid, legal defense, medicaid audit, Medicaid defense attorney, Medicaid fraud, Medicaid fraud defense lawyer, Medicaid numbers, Medicaid scheme, mental health professional, mental health service program|Comments Off

New Mexico’s Largest Mental Health Providers Accused of Defrauding Medicaid Out of $36 Million

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

For months now, 15 New Mexico behavioral health agencies have been the subject of a Medicaid fraud investigation. The state’s largest mental health providers had their Medicaid funding frozen by the New Mexico Human Services Department (HSD) due to credible allegations of fraud, according to KUNM News. The behavioral health agencies are accused of collectively defrauding Medicaid of $36 million over three years. The findings in an audit conducted in 2012, by OptumHealth, the contractor that handles Medicaid payments for New Mexico’s behavioral health system, alarmed state officials to the point that they hired Public Consulting Group (PCG), a firm that specializes in Medicaid fraud, to conduct another audit in June 2013.

These behavioral health agencies […]

By The Health Law Firm|2024-03-14T10:01:50-04:00May 15, 2018|Categories: Medicaid audit, Medicaid fraud, Mental Health Counselor, Mental Health Counselor Law|Tags: Attorney General (AG), behavioral health agencies, defense attorney, defense lawyer, Department of Justice (DOJ), false billing, false claims, false claims act, legal representation, medicaid, medicaid audit, Medicaid false claims, medicare, medicare audit, Medicare false claims, Medicare fraud, mental health providers, Public Consulting Group (PCG), qui tam, qui tam lawsuits, settlement agreement, the health law firm, whistleblower, whistleblower attorney, whistleblower lawyer, whistleblower protection|Comments Off

Mother and Daughter-In-Law Arrested for Allegedly Defrauding Medicaid Out of More Than $70,000

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A mother and daughter-in-law duo each face up to 30 years in prison for allegedly defrauding the Florida Medicaid program out of more than $70,000. According to a press release from the Florida Attorney General (AG), released February 20, 2014, the pair was arrested for allegedly running a scheme that involved billing the Medicaid program for services never rendered.

Click here to read the press release from the AG.

Mother and Daughter-In-Law Claimed to Provide Services to Developmentally Disabled Child.

According to the AG, the mother and daughter-in-law allegedly ran a scheme that involved billing the Medicaid program for services that were not actually provided to the mother’s developmentally disabled son. It’s alleged the mother submitted timesheets for work that was not provided. The […]

By The Health Law Firm|2024-03-14T10:01:51-04:00May 15, 2018|Categories: Medicaid audit|Tags: Attorney General (AG), defense attorney, defense lawyer, false claims, falsified records, florida attorney, Florida Attorney General, Florida lawyer, Florida Medicaid, Florida Medicaid Program, fraudulent claims, health law firm, medicaid, medicaid audit, Medicaid claims, Medicaid fraud, medicaid fraud control unit, Medicaid fraud defense attorney, Medicaid fraud defense lawyer, Medicaid investigation, mfcu, services never rendered, the health law firm|Comments Off