Meaningful Consequences

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Cute baby girl with her mother at paediatrician's office.Female doctor examining cute baby girl

Medicaid providers who steal from the government healthcare program by billing for services they don’t deliver eventually face severe consequences for committing Medicaid fraud. That is the message received (loud and clear, might I add) from federal prosecutors in Georgia who recently won major civil judgments against a Medicaid provider and the business owner they say stole from the state program for years.

The U.S. District Court for the Southern District of Georgia ordered the Brunswick-based Miracle Home Care Inc. to pay $9.7 million and its owner to pay $400,000 to the government. The two were found to have repeatedly filed false claims for thousands of dollars in fraudulent non-emergency transportation and adult health services, including falsifying thousands of records. (It was a miracle they weren’t caught sooner.)

The Medicaid program provides health benefits to low-income families who either have no medical insurance or inadequate medical insurance. The federal government establishes the general Medicaid guidelines, but program requirements are established and monitored by each state.

Medicaid Fraud Control Units operate in 49 states and Washington, D.C. In fiscal 2017, they recovered $1.8 billion from fraud cases that included 1,528 criminal convictions involving $693 million and 961 civil judgments worth $1.1 billion, according to the U.S. Department of Health and Human Services’ Office of Inspector General.

If you suspect fraud, report it to your state Medicaid office to prevent fraudsters from taking advantage of vulnerable beneficiaries who deserve to receive these government healthcare benefits.

Today’s Fraud of the Day comes from a U.S. Attorney’s Office for the Southern District of Georgia press release, “Government obtains $10.1 million in judgment to resolve Medicaid fraud claims in False Claims Act complaint,” published on Dec. 17, 2019.

BRUNSWICK, GA:  A Brunswick Medicaid provider and its owner have been ordered to pay more than $10 million to settle a civil fraud complaint filed by the federal government and the state of Georgia.

The judgments, approved by the U.S. District Court for the Southern District of Georgia, awards the government $9.7 million against Brunswick-based Miracle Home Care, Inc. and $400,000 against its owner, Shashicka Tyre-Hill of Brunswick, said Bobby L. Christine, U.S. Attorney for the Southern District of Georgia.

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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.