Attorney General Chris Carr announced last week actions in two cases involving the Comprehensive Supports Waiver Program” (“COMP”), the COMP is a Medicaid waiver program that provides services and support for people with intellectual or developmental disabilities. In both cases, it is alleged that providers working under the COMP program improperly reported work on timesheets in order to gain financial benefit.
“Our Medicaid Fraud Control Division should be proud of the work they are doing to protect the integrity of the programs we have in place to support Georgians with intellectual or developmental disabilities. When funds dedicated to those programs are fraudulently diverted, not only do our vulnerable populations suffer, but the taxpayers of Georgia are harmed as well,” said Carr.
Case # 1 – Conviction: March 13, 2019
On March 13, 2019, Georgia resident Paula Houston pled guilty to one count of Medicaid Fraud in Cobb Superior Court.
Ms. Houston’s fraud arose from when she was employed by co-defendant Otis Nettles under the Medicaid COMP program to provide personal support services to Mr. Nettle’s daughter. Houston began providing services in 2015 and Nettles submitted her timesheets to the Acumen Fiscal Agent for the hours she claimed to have worked. Houston was paid accordingly. However, around the same time, Nettles hired others to provide services for his daughter, including Paris Thomas who also worked for Nettles in 2015, but not into 2016.
An investigation by the Georgia Medicaid Fraud Control Division (“GMFCD”) revealed that timesheets were submitted to Acumen for hours allegedly worked by Paris Thomas in March of 2016, when she was no longer working for Nettles. Additional timesheets were submitted for another person, Angel Bradham, who was never actually hired by Nettles. The fraud investigation revealed that the money paid for the Thomas and Bradham hours actually went to Houston. Pursuant to a negotiated plea, Houston pled to one count of Medicaid Fraud and was sentenced to ten years of probation, exclusion from providing services to or receiving funds from Georgia Medicaid, ordered to pay $6,208.41 in restitution, and Houston is required to testify truthfully against Nettles, if his case proceeds to trial. Houston was permitted to plead under the First Offender Act.
The case was investigated and prepared for prosecution by the Georgia Medicaid Fraud Control Division: Chief Intelligence Analyst Tish Murray, Investigator Sadarius Miley, and Forensic Auditor Maria Aman. The prosecution was conducted by Assistant Attorney General Elizabeth K. Grofic.
Case # 2- Indictment: March 18, 2019
Tongala Evans and Shaniquea Brazil, Georgia residents, were indicted on ten counts of Medicaid Fraud, one count of False Writings, and one count of Conspiracy to Defraud the State on March 18, 2019 in Spalding County Superior Court.
Evans used COMP, to employ Brazil to provide personal support services to her cousin. Evans and Brazil stated that Brazil began providing services in October 2015, and they submitted timesheets to Acumen Fiscal Agent for the hours Brazil claimed to have worked. Acumen would then provide compensation for Brazil’s services by depositing funds directly onto a pay card.
Investigation by the GMFCU revealed that throughout the time when Brazil claimed to be providing services, the patient attended a day program from about 7:30 a.m. until about 2 p.m. Interviews with witnesses and evidence from a transportation provider revealed that the patient was then transported to a caretaker until about 5 p.m. However, the timesheets submitted by Brazil and Evans billed for Brazil’s services during the time when the patient was at the caretaker’s home. The total loss to the State was $33,151.50.
The preliminary investigation was conducted by Department of Community Health Office of Inspector General Investigator Cameron Daniels. The case underwent further investigation and was prepared for prosecution by the Georgia Medicaid Fraud Control Division: Chief Intelligence Analyst Tish Murray, Investigator Lee Thompson, Forensic Auditor Cecilia Isaac Vazquez, Intelligence Analyst Vanda Russell, and Nurse Investigator Victoria Hall. The prosecution was conducted by Assistant Attorney General Jessica R. Hall.
This is a press release from the Office of Attorney General Chris Carr.