Family Dysfunctions

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41709479 - patients concept. word on folder register of card index. selective focus.

If you’re billing the government for services that you never provided, you’re committing fraud. (Just a general rule of thumb.) As stated in a press release, the Georgia Attorney General’s office prosecuted a woman who owned and operated an Atlanta-area behavioral health clinic for submitting to Medicaid hundreds of thousands of dollars in illegal claims. (The so-called ”Family Functions” clinic turned out to be downright dysfunctional.)

In less than two years, this woman billed the government-sponsored health care program for more than $650,000 in services through her main office and another facility in northern Georgia. When the Georgia Medicaid Fraud Control Unit investigated the nature of the high volume of claims being submitted by this single clinic, it uncovered that the owner charged the government for appointments with Medicaid recipients that it never actually treated, visits that were improperly documented or services that were incorrectly documented. Ultimately, the stolen money didn’t even go back into the clinic, but was instead spent on personal things. (That’s a heck of a wad of discretionary income.)

The clinic owner pleaded guilty to Medicaid fraud and was sentenced to spend next decade of her life on her best behavior (along with a significant lifestyle change). After she serves two years in prison, she’ll be on probation for another eight. She must also repay the government a total of $659,183.

Purposefully targeting Medicaid patients, with the expectation that the government is not paying as much attention as private health insurers, is just not the way to function.

Source: Today’s ”Fraud of the Day” is based on, ”Woman Pleads Guilty to Medicaid Fraud,” a press release by the Georgia Attorney General’s office on January 22, 2016.

E’Terica Rucks was sentenced to two years in prison followed by eight years on probation after pleading guilty to Medicaid Fraud. As part of the sentence Rucks will have to pay restitution in the amount of $659,183.44 to the State.

Between July 19, 2010 and June 25, 2012, Rucks owned and operated Family Functions, LLC, which held itself out to the public as a behavioral health provider that served many Medicaid recipients in both the Atlanta area and at a satellite site in northern Georgia. An investigation by the Georgia Medicaid Fraud Control Unit revealed that Rucks’ business submitted numerous claims for payments that were fraudulent in nature.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.