Georgia AG: Medicaid Fraud Division Recovered More Than $8.5M in 2019 for Taxpayers

Attorney General Chris Carr has announced that the office’s Medicaid Fraud Division recovered more than $8.5 million in taxpayer dollars in the 2019 federal fiscal year.

“I commend the hard work of Attorney General Chris Carr and the Medicaid Fraud Division,” said Governor Brian Kemp. “Their dedicated efforts hold bad actors who take advantage of much-needed programs accountable, while protecting our most vulnerable and safeguarding Georgians’ hard-earned tax dollars.”

“Through hard work and persistence, our Medicaid Fraud Division has once again recovered millions of dollars for the taxpayers of Georgia” said Attorney General Chris Carr. “Fraud and abuse within our publicly-funded programs harms our state’s most vulnerable citizens, takes advantage of those who play by the rules and will not be tolerated by our office.”

The Georgia Medicaid Fraud Division has three principal responsibilities: investigate criminal fraud committed by Medicaid providers; investigate abuse and neglect of patients in healthcare facilities funded by the Medicaid program; and collaborate with local, state and federal authorities on investigations and prosecutions.

Under Attorney General Carr’s leadership, the Medicaid Fraud Division has emphasized investigations involving the abuse of older or at-risk adults, schemes involving opioid over-prescribing and dispensing and scams targeting Medicaid beneficiaries.

The Division has approximately 500 active investigations.

Here are a few examples of Medicaid fraud:

• Mental health counselors billing the program for individual therapy services to juveniles when the children were simply attending an after school daycare.
• Door-to-door “marketers” offering individuals cash or gift cards to provide their personally identifying health information that is later used to bill for medically unnecessary lab services.
• Scams involving durable medical equipment, such as back braces, where individuals receive this equipment without ever requesting or needing it.
• A physician billing for office visits when he is out of the country.
• Medical practices using unlicensed or untrained staff to provide services that require training and licensing from the State.
• The diversion of personally-directed waiver funds to individuals who never provide services to the Medicaid beneficiary.
• The billing of ambulance services for personal trips or errands.
• An unlicensed personal care home taking in patients, diverting their benefits and depriving them of appropriate care.

You can report fraud or abuse to our Medicaid Fraud Control Division by calling 404-656-5400 or e-mailing report_medicaid_fraud@law.ga.gov.

Case Highlights:

Targeting Abuse of Older, At-Risk Adults

The neglect and trafficking of at-risk adults is unfortunately a sordid reality in Georgia. Cases range from physical harm, abuse and neglect to exploitation where individuals, under the guise of providing care, pilfer the victim’s benefits and assets for personal gain. Our office will remain focused on these cases with an emphasis on taking down unlicensed personal care homes.

In 2019, our office announced that we will be jointly prosecuting seven individuals for designing and carrying out a coordinated scheme to traffic disabled adults. The West family, Eric West, Valerie West, and Erica West owned and operated a series of homes which housed elder and disabled individuals, often with serious mental and physical disabilities. The three would obtain control over the individuals’ finances and house them in unsafe and unsanitary conditions. The homes were infested with bed bugs and roaches and at times lacked electricity and hot water. The West family obtained thousands of dollars by directly using the Social Security funds of disabled and elderly individuals for their own benefit and by trafficking those disabled and elderly adults between their businesses and billing the government.

This scheme designed and led by the West family also included two nurses who failed to report these egregious conditions to authorities and an employee at a mental health facility who helped recruit victims for the West family.

Medicaid Fraud Division led this investigation and will be representing the State in the prosecution along with the DeKalb County District Attorney’s Office.

Read more here.

Cracking Down on Egregious Over-prescribing of Opioids

While most medical professionals have their patients’ well-being at the forefront of their decision-making, there remain a few who prey upon those suffering from pain to feed addiction and line their pocket-books at the same time.

The Medicaid Fraud Division partnered with the United States Attorney’s Office for the Southern District of Georgia earlier this fall in the successful prosecution of Dr. Frank H. Bynes, Jr. Dr. Bynes is an unfortunate example of an individual who used his physician’s license and prescribing privileges as a means of manipulating many female patients whom he coerced into inappropriate personal relationships. Particularly when powerful opioids are involved, doctors are expected by law and by ethical requirements to avoid relationships which can compromise their professional judgment. Sadly, Dr. Bynes elected to use this power to facilitate personal needs rather than the medical needs of his patients.

After a three day trial, the jury found Dr. Bynes guilty of 13 counts of illegally dispensing a controlled substance and 3 counts of healthcare fraud. He is currently awaiting sentencing.

Read more here.

Dismantling Schemes Targeting Medicaid Beneficiaries

In late September, the Medicaid Fraud Division participated in a national initiative, including the U.S. Attorney’s Office for the Southern District of Georgia, in announcing charges against multiple physicians for their involvement in a national telemedicine scam for medically unnecessary genetic cancer screening tests and DME equipment.

Read more here.