Alaska takes on its first 2019 Medicaid fraud cases
A special Alaska prosecution team has accused four people of attempting to defraud the state's taxpayers in medical billings — including a woman who allegedly charged for services she couldn’t have provided because she was on a European vacation at the time.
Nicole White, 31, is charged with 10 counts of medical assistance fraud, two of them felonies, in connection with what the state’s Medicaid Fraud Control Unit (MFCU) calls “travel billing” — charging for services the provider wasn’t present with the patient to perform.
According to a charging document against White, the case is linked to $1,400 in fraudulent billing of personal care assistant (PCA) services for two clients during August 2017. The unit received a complaint last June, which was corroborated by further investigation.
"[White] could not have provided PCA services to [the patients] because she was overseas, on vacation in Spain, during the reported time period," prosecutors wrote.
The state received four separate weekly timesheets from White in August 2017 for each of the two patients, prosecutors said. Every one of them falsely claimed she had provided care during her vacation, which she confessed to during questioning in July 2018.
"[White] admitted that she did not and could not provide the PCA services reported because she was away from her clients, traveling in Spain," prosecutors wrote. "[She] agreed that she thought she would get away [without] anyone learning that she did not actually provide the reported PCA services."
White's case is among the first of 2019 filed by the MFCU, an arm of the state Department of Law that retrieved more money for the state during its latest fiscal year than it cost to run.
Since 1992, the unit has been “investigating and prosecuting Medicaid fraud and the abuse, neglect or financial exploitation of patients in any facility that accepts Medicaid funds” according to its website. Its recent successes include a 2015 sentence in an estimated $1.6 million of overbilling by the Mat-Su Activity and Respite Center, as well as a nearly $2.3 million settlement with the Arc of Anchorage regarding overbilling of its services.
In September 2018, a jury found Flamingo Eye Corp. owner Margaret Williams guilty on several charges in connection with what the unit called “several hundred thousand dollars” of services billed but never provided at Flamingo Eye assisted-living homes in Alaska. The investigation stemmed from the 2015 murder of caretaker Glenna Wylie at Anchorage’s Eye To Eye home by patient Gilbert Nashookpuk, who was sentenced to 60 years in prison in 2017.
Assistant Attorney General John Cagle, the unit's head, says similar fraud units — a creation of federal law — operate in the District of Columbia and all states except North Dakota, which is in the process of starting a unit due to a recent loss of their waiver. The two newest Units, Puerto Rico and the Virgin Islands, were certified in December 2018.
Alaska's MFCU receives 75 percent of its funding, including nearly $1.9 million in the federal 2018 fiscal year, from the federal government. During the same time period, the unit received awards of roughly $1 million in fines and recovered roughly $1.3 million in state restitution judgments, plus about $568,000 in nationwide cases and $50,000 from judgments in previous years.
The three main sources of Alaska cases, Cagle said, were personal care assistants and non-licensed practitioners at 29 percent, followed by facility-based fraud at 19 percent and non-physician licensed practitioners at 15 percent.
In another set of cases filed this year, Kenai care recipient Betty Joanne Fox and two of her caretakers — Jeanlynn Kana Johnson, 27, and Tara Colleen Nunley, 39 — were each charged with misdemeanor medical assistance fraud.
Johnson, the first person charged in the scheme, had been reported by Kenai-based PCA provider Consumer Direct. The allegations stemmed from services Johnson reported providing to Fox, to the tune of “40.5 hours of potentially fraudulent work per week,” from January 2014 through May 2015.
“The timesheets were clearly photocopies, including etched over dates on the signature lines, identical signatures, identical times for performing various services, identical number and extent of services performed, etc.,” prosecutors wrote. “In total, Medicaid paid approximately $19,000 for services reflected in the photocopied timesheets.”
When asked about the timesheets, prosecutors said Johnson admitted that she actually performed about five hours a week of “nominal work” for Fox, 73, with whom she fabricated the timesheets and split the resulting pay.
“Johnson would get paid $16 [per hour] from Consumer Direct, and then Johnson would pay Fox $100-$200 per pay period or per week for her cooperation,” prosecutors wrote. “Johnson stated that the whole scheme was Fox’s idea, and she knew it was wrong and a crime, but she committed the crime because she was poor and needed the money.”
The second case, involving Fox and Nunley, spanned from October to November of 2017.
"Together, the two women worked together to dupe the Department of Health and Social Services into securing approval for Fox to have approximately 40 hours of PCA and respite services per week," prosecutors wrote. "Nunley and Fox then filled out fraudulent timesheets so that Nunley could get paid for a 40 [hour-per-week] job while only really performing nominal amounts of PCA work for Fox."
When investigators watched Fox’s home that month in connection with the Johnson case, however, Nunley was only present “for only a short period of time, or not at all, on any particular day during the month of surveillance.” During a subsequent surveillance of Fox on Dec. 22, an investigator said she wasn’t “acting consistently with needing full-time assistance with any activities of daily life.”
When pressed about the statements, prosecutors said Nunley admitted to the scheme.
“In Nunley’s words, Fox did not need any PCA work done for her, and did not have any PCA work done for her, other than Nunley acting like a taxi driving Fox around town when Fox wanted to go to bingo or the bar,” prosecutors wrote. “Nunley stated that her husband was out of work and she needed the money. Nunley stated Fox was worried she would lose her Medicaid if the two women did not use all the hours.”
Court records show Fox, Johnson and Nunley, the Kenai defendants, scheduled for arraignment on Jan. 31 in Kenai court. White is set for a Feb. 1 arraignment in Anchorage.
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