Medicaid Fraud, Waste and Abuse Curator: Volume 1

From stories collected week of Oct 29, 2018

In this issue..

Medicaid FWA Curator- Vol 1

Billions In ‘Questionable Payments’ Went To California’s Medicaid Insurers And Providers

California’s Medicaid program made at least $4 billion in questionable payments to health insurers and medical providers over a four-year period because as many as 453,000 people were ineligible for the public benefits, according to a state audit released Tuesday….


Massachusetts Health Care Company Owner Charged with Tax Fraud

Two Weymouth, Massachusetts women are facing charges of tax evasion in connection to a home health care company they co-owned in Boston. Sheila O’Connell, 33, and Hannah Holland, 51, were both charged with one count of conspiracy to defraud the United States and three counts of aiding and assisting in the preparation of false tax returns….


Albuquerque psychiatrist over-medicated hundreds of children in his care

Unlike many doctors, Albuquerque psychiatrist Edwin Bacon Hall, 74, accepted patients on Medicaid and saw them in a timely manner. He often treated foster children, who were sent his way with the approval of their legal guardian, the Children Youth and Families Department (CYFD)….


Nurse pleads guilty to stealing opioid drugs while at Johnson County care facility

A Johnson County nurse has pleaded guilty to stealing opioid drugs while working at a residential care facility in Gardner, Kan. Jeremy Keith Bailey pleaded guilty Thursday in Johnson County District Court to possession of a controlled substance, theft and Medicaid fraud….


Prosecutors dismiss health care fraud charges against Dr. Roland Chalifoux

WHEELING, W. Va. (WTRF) – A three and a half year legal battle in West Virginia’s Northern District Court has come to an end. In what the U.S. Attorney’s office is calling a “rare move,” federal prosecutors motioned to dismiss pending charges of health care fraud against Dr. Roland Chalifoux, Jr. Dr. Chalifoux, 58, was indicted in June 2017 in a 32 count indictment that alleged crimes ranging from health care fraud, wire fraud, and mail fraud. He was alleged to have wrongfully billed insurers, including Medicaid, for visits at which he was not present…


Audit: Ohio Medicaid paid $90.5 million to deceased people; owes feds $38 million

Ohio Medicaid paid out $90.5 million in coverage to individuals who had already been deceased, an audit by the Office of the Inspector General claims. After the federal audit analyzed a random sample size, it estimated that Ohio Medicaid failed to recover $51.3 million of those funds; $38 million of which were part of the federal share, which Ohio Medicaid owes back to the federal government….


Mississippi man pleads guilty to misusing mother’s money

JACKSON, Miss. (AP) — A Mississippi man has pleaded guilty to spending his mother’s money on himself, rather than paying her medical bills. WLBT-TV reported that 62-year-old Steven Adkins of Madison pleaded guilty Monday to one felony count of exploitation of a vulnerable person. Adkins was sentenced to 10 years in prison….


Austin psychologists convicted in multiple charges after fraud investigation

AUSTIN — A federal jury on Monday convicted two Austin-area psychologists on numerous charges after a fraud investigation at their establishment, Psychological A.R.T.S., P.C. After a three-week-long trial, the jury convicted Dr. William Joseph Dubin, 73, and his son, Dr. David Fox Dubin, 33. William was found guilty of one count of conspiracy to pay and receive health care kickbacks, and two counts of offering to pay and paying illegal kickback, while his son was found guilty of one count of conspiracy to commit health care fraud, one count of health care fraud and aiding and abetting health care fraud, and one count of aggravated identity theft….


Nursing home settlement involves former owner of Hagerstown facility

BALTIMORE — The former owner of a nursing home north of Hagerstown was the defendant in a lawsuit settled last week with the state attorney general’s office. NMS Healthcare agreed to pay $2.2 million to the attorney general’s Medicaid Fraud Control Unit, and the company and its owner, Matthew Neiswanger, are prohibited from operating in Maryland, according to the settlement….


NJ Comptroller: Illegal Medicaid Amnesty Deals Cut in Lakewood Case

A discrepancy has emerged in the office of the New Jersey state comptroller between the controller, Phillip J. Degnan and three levels of managers who work for him. The issue is in regards to the repayment of Medicaid fraud to taxpayers. Degnan said that one of his employees went rogue by discounting $2.7 million on the repayment while the managers said the office knew about the already knew about the arrangements…


Two home health agency owners and two employees convicted for roles in $3.7 million home health fraud scheme

Washington, DC, October 30, 2018—A federal jury found two home health owners and two employees guilty today for their roles in a scheme to bill Medicare and Medicaid for over $3.7 million in charges when the owners had previously been excluded from participating in federal health-care benefit programs…


Bridgeport Woman Pleads Guilty To Medicaid Fraud

BRIDGEPORT, CT — A woman accused of defrauding the state through identity theft of Medicaid patients. Nikkita Chesney, 45, of Bridgeport pleaded guilty to one count of health care fraud and one count of aggravated identity theft. She admitted to stealing the identity information of 150 Medicaid clients from her employer and using about half that information to file false billings to Medicaid, according to the U.S. Attorney District of Connecticut. She said her co-conspirators also falsely billed Medicaid…


Auditor: DSHS failed to catch, report employee welfare fraud

OLYMPIA — A Department of Social and Health Services supervisor who was one of Kitsap County’s top welfare cheats over the past 10 years was able to rip off the system because the process the department used to determine her eligibility was not “effectively performed.”…


2 people convicted for million dollar welfare fraud in Louisiana

BATON ROUGE, La. (LADOJ) – Two individuals have been convicted for a welfare fraud scheme costing Louisiana over $1 million. Lanice Stamps, 39 of New Orleans, pled guilty to one count of Felony Theft and was ordered to pay $1,059,709.76 towards restitution for the money stolen and $300,000 to the MFCU in civil monetary penalties. She was also ordered to execute a mortgage to repay the State for Medicaid monies she used to pay her home mortgage…


Suffolk doctor charged in drug-testing scam, state AG’s office says

A Suffolk doctor who owns a laboratory cheated state Medicaid out of nearly $1 million in a four-year drug-testing scam, the state attorney general’s office said Tuesday. Edwardo M. Yambo, 70, of Lake Grove, stole $939,000 between 2012 and 2016 by “routinely” submitting bills for drug testing services that his laboratory did not or could not perform and for services that were not medically necessary, according to Attorney General Barbara D. Underwood. For example, instead of charging for one test on a patient, he often charged the state’s healthcare program for low-income residents for 11 nonexistent tests, said agency spokesman Jordan Carmon…


Man pleads guilty to medicaid fraud


JACKSON, Miss (WJTV) – Steven Adkins of Madison will spend 10 years in prison after pleading guilty to spending his mother’s money instead of paying her medical bills. Adkins, 62, was sentenced Monday to 10 years on one felony count of exploitation of a vulnerable person by Madison County Circuit Court Judge William Chapman. An investigation by the Attorney General’s Medicaid Fraud Control Unit found that Adkins depleted his mother’s funds in excess of $30,000 between March and December 2017….


State Attorney Brings Medicaid Fraud Charges Against Waterbury Man

A 49-year-old Waterbury man has been arrested and charged with a scheme to defraud Medicaid of nearly $2,800 by allegedly claiming to provide at-home care to an elderly disabled man who was actually in a nursing home. Investigators arrested Albert Haddad and charged him Friday with one count each of health insurance fraud and first-degree larceny by defrauding a public community. Haddad was released on a $15,000 bond and is scheduled to appear in Hartford Superior Court Nov. 6. Both charges are Class B felonies punishable by up five years in prison…



A Jefferson County couple is facing six felony counts of alleged abuse and neglect of a vulnerable Kentuckian, and theft and fraud of the Kentucky Medicaid Program, according to Attorney General Andy Beshear….