Gross Misconduct

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11941577 - pills and money - business medical background

People get fired for misconduct all the time. Some are simply disobedient, insubordinate, or don’t show up on time for work. Things get a little more serious when it comes to sexual misconduct and when corporate officers use the power of their position to mismanage their company, it can mean jail time. The former CEO of a now defunct Merced, California health clinic is in deep trouble for Medicaid fraud as a result of the mismanagement of her business. Read on to find out about the myriad of things she did to get wealthy from Medi-Cal, California’s Medicaid program.

The woman-owned clinic, which is described as a non-profit public benefit corporation serving multiple communities including Mariposa, Madera and Stanislaus counties, provided medical, dental and chiropractic services. The former founder and chief executive officer (CEO) used her company to bill Medicare and Medi-Cal for services she knew were not reimbursable. (Her illegal scam, which involved the treatment of thousands of low-income patients, netted her more than $3.7 million.)

Here are some of the ways the former CEO collected government funds she did not deserve:

  • Patient medical and billing records were falsified so bills could be submitted to Medicare and Medicaid for payment.
  • Unnecessary tests were ordered and patients were required to return to the clinic, even though they really didn’t have to.
  • Kickbacks were collected for sending work to a medical testing lab. (She made about $1,000 per month.)
  • When business was slow, staff members covered by Medi-Cal were seen as patients to increase the amount of reimbursements received by the clinic.
  • Patients saw unlicensed counselors but were billed for a visit with a licensed clinical social worker.
  • Unlicensed foreign medical students prescribed unnecessary opioids to patients.
  • Medi-Cal was billed when patients had office visits with licensed doctors, but they actually received opioids in the parking lots of McDonalds and Rite Aid. (Fast food and illegal drugs. Can’t beat that combination of one-stop shopping.)
  • The medical clinic clipped toenails but billed the government insurance programs for fungal toe infection treatment. (The government is not in the business of paying for pedicures.)

The former CEO, who was also a licensed nurse practitioner, originally denied any misconduct in connection with the eight clinics. Due to a debilitating stroke, she ended up pleading guilty to healthcare fraud to avoid the time and expense of a trial. As part of her agreement, other family members employed at the clinic including her daughter, son-in-law, and husband were not charged.

The 57-year-old woman who masterminded the scheme is currently awaiting sentencing. She is facing two decades behind bars and a fine of twice the amount of her gain from committing the crime. (That tallies up to about $7.4 million.) To say that this woman is guilty of gross conduct is an understatement. She used her position to bill the government incorrectly for 36,800 patient visits. Then she used taxpayer dollars as pocket change. (That’s not only gross misconduct, it’s just plain disgusting.)

Today’s “Fraud of the Day” is based on a Department of Justice press release entitled, “Merced Former CEO and Licensed Nurse Practitioner Pleads Guilty to Health Care Fraud,” released on August 13, 2018.

FRESNO, Calif. — Sandra Haar, 57, of Merced, pleaded guilty today to health care fraud and conspiracy to receive kickbacks, U.S. Attorney McGregor W. Scott announced.

Haar was the founder and chief executive officer of Horisons Unlimited, a nonprofit public benefit corporation that provided health and dental services in Merced and surrounding communities. According to court documents, between January 1, 2014, and March 2017, Haar orchestrated a scheme to bill Medicare and Medi-Cal for services she knew were not reimbursable, and she profited by over $3.7 million from her fraud. For example, Haar billed Medi‑Cal for health and dental services that were not rendered and for unnecessary health care services. She also billed Medi-Cal for office visits with purportedly licensed doctors when the patients instead were dispensed Suboxone, an opioid medication, in the parking lots of McDonald’s and Rite Aid in baggies.

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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.