Fraud Intervention

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The point of an intervention is to disrupt how something is being done so that change can occur. If done properly, interventions can help with alcohol or substance abuse, unruly adolescents, distressed families or children with severe emotional disturbances. The owner of a Fayetteville, Georgia organization that provides mental health, substance abuse and other intervention services for children and their families recently experienced an intervention from the Department of Justice. Instead of receiving a conviction for a Medicaid fraud scheme, the owner agreed to pay $645,000 to resolve False Claims Act allegations. (Sounds like it was a successful intervention.)

At the direction of the owner, the Fayetteville-based organization whose purpose is to provide intervention services to those struggling with mental health and addictive diseases, submitted false claims to the Georgia Medicaid Program for services that were never provided. (The ruse which violated the False Claims Act occurred for almost two years.)

The corporation was enrolled with the Georgia Department of Community Health to provide behavioral health services for Medicaid beneficiaries through two programs. One program provided a community-based service for adults with severe and persistent mental illness and the other provided outpatient mental health services for patients of all ages. (Obviously, these are two important programs that provide necessary mental health services for vulnerable Medicaid beneficiaries.) After receiving a tip, the Georgia Medicaid Fraud Control Unit opened an investigation and the rest is history.

The owner of the Georgia-based company agreed to make amends with Medicaid by paying $645,000 to avoid a Medicaid fraud conviction. The agreement between the owner and the government settles the allegations against the mental health service provider, but doesn’t determine guilt or liability for the company. (Sounds like the owner got a pretty good deal. No conviction or jail time in exchange for a big check.) In addition to the money owed, the mental health services provider is not allowed to participate in federal healthcare programs for five years.

Just as interventions can be a powerful force of change in the lives of those who desire to live a more productive and enjoyable life, today’s article highlights a successful intervention that not only protects federal healthcare programs, but also beneficiaries who deserve to receive quality healthcare. This case’s outcome also sends a very loud message to other providers who are thinking about doing the same thing. (Let’s hope that this intervention has cured this provider from her fraudulent behavior.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, Families United Services and Pamela McKenzie to pay $645,000.00 and agree to exclusion in order to resolve False Claims Act allegations,” released on February 6, 2019.  

ATLANTA – Families United Services, Inc. (FUS) and Pamela McKenzie, the owner of FUS, have agreed to pay $645,000, and to be excluded from federal health care programs for a period of five years to resolve allegations that they submitted claims to the Georgia Medicaid Program for behavioral health services that they never provided.  The effect of the exclusion is that federal health care programs will not make any payments to FUS or McKenzie, or anyone who employs them, for any services that they have provided.

“Georgia Medicaid provides valuable mental health services and treatment for many of Georgia’s most vulnerable citizens,” said U.S. Attorney Byung J. “BJay” Pak. “False billing of the Georgia Medicaid Program diverts monies for citizens who depend on Medicaid for vital medical care.  Our pursuit of individuals who defraud federal health care programs will not cease.”

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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.