State Prosecutes Large Medicaid Fraud Case
The state is prosecuting the largest Medicaid fraud case in its history. The Medicaid fraud division filed charges today (Tuesday) against 28 personal care attendants, who take care of elderly and disabled people in their homes. Department of Law Division Director John Skidmore says the cases represent about $360,000 in fraudulently billed services:
“The number of charges filed today are the greatest number of charges filed on a single day in the history of the state of Alaska for Medicaid fraud charges. There are other multi-state settlements that have resulted in millions of dollars against large corporations, most of them drug companies, but nothing for individual citizens in the state of Alaska that’s been as large as this.”
According to the charging documents, the investigation started after a nurse who works for the state’s Division of Senior and Disability Services tipped off the Medicaid fraud unit in February. A 91 year old woman reported to the nurse that she was pressured into accepting personal care attendant services from an employee of Good Faith Services. The woman said the attendant then stopped coming to her apartment.
All but two of the personal care attendants charged in the case work or worked for Good Faith Services. Skidmore alleges most were involved in one of two schemes:
“Billing for services being provided at the same time for more than one individual… (and) people who were billing for services provided when they weren’t even in the country.”
The state is also charging one Medicaid recipient for allegedly splitting funds with their personal care attendant. The state is not filing charges against Good Faith Services at this time. The company’s lawyer, Chester Gilmore, says according to the charging documents the fraud was widespread but very specific to the individual personal care attendants.
“It’s easy to… think Good Faith Services itself somehow profited from this or their business had some sort of advantage from it, but that’s absolutely not the case. This kind of small scale fraud would be disastrous to this company. This company’s interests are precisely what they’re doing, which is cooperating with the government.”
Gilmore says the company tipped off the state to the actions of some of its employees who were allegedly committing fraud. He says the company employs about 300 personal care attendants.
The state’s Medicaid fraud unit has double the number of investigators it did one year ago thanks to a bill state lawmakers passed. Andrew Peterson is director of the unit. He says the extra investigators have allowed the state to significantly boost the number of cases it’s prosecuting:
“The idea is that with a more active presence by a Medicaid Fraud Control Unit, in addition to gaining restitution for the state by getting back the money that was fraudulently paid, we can also deter others who might have thought it was a good idea to defraud the Medicaid system and will now have a second thought.”
As of today, none of the personal care attendants charged in the case will be able to bill Medicaid, pending the outcome of the charges.
This story is part of a partnership between APRN, Kaiser Health News and NPR.