A significant number of Medicaid fraud allegations begin when statistical studies of billing procedures trigger an audit. Unfortunately, this can have devastating consequences for health care providers who have done nothing unlawful. Innocent billing errors or an unusual pattern of bills can result in criminal investigations which often reveal that someone has made a common billing mistake but has not intended to commit health care fraud.
Recently, the Attorney General’s Medicaid Fraud Control Unit, with the assistance of the East Baton Rouge Parish Sheriff’s Office, arrested a personal care attendant from Baton Rouge. Authorities believe the 25-year-old woman fraudulently submitted claims for services she did not provide.
Medicaid providers hire personal care attendants to care for Medicaid patients who are physically and mentally impaired. These attendants are required to complete service logs with information regarding the dates and times they worked with each client. In order to get paid, the attendants submit these logs to Medicaid.
According to the authorities, the woman in this case submitted a service log with false information. She apparently sent in timesheets requesting payment for a range of services, including cooking, cleaning and bathing, she provided to a patient. However, the patient named was receiving care at a nursing facility on the dates and times listed.
It is no secret that health care providers deal with a flurry of paperwork for Medicaid each day. It is completely understandable that a mistake may slip through the cracks. By simply recording the wrong date, time or even patient name, a personal care attendant may become the target of an aggressive criminal investigation. In this type of situation, it is a good idea to consult with an attorney who can make sure the defendant’s side of the story is heard.
Source: KATC.com, “AG’s Medicaid Fraud Control Unit Arrests Baton Rouge Woman,” Kate Durio, 15 April 2011