New Jersey Medicaid Fraud Case Leads to Lengthy Prison Sentence

A man in Cherry Hill, New Jersey is now facing jail time after allegations of Medicaid fraud, including criminal charges, based on claims that he used unqualified healthcare workers to bill the federal government program for services rendered. The man was sentenced to 70 months in prison after a comprehensive investigation and case over Medicaid fraud and embezzlement.

Medicaid Fraud Case Leads to Lengthy Prison Sentence and More

The individual accused of Medicaid fraud lived in Camden and operated a nonprofit designed to help the poorest residents of the area. That director was also accused of taking money directly from the nonprofit when he shouldn’t have. He had already plead guilty to conspiracy to commit healthcare fraud and healthcare benefit program embezzlement. In addition to the prison time, he will face three years of supervised release and has to pay back restitution to the tune of $2.5 million.

Although the judge sentenced him to 70 months and other consequences, he could have faced up to ten years in prison. The executive director’s wife also previously plead guilty to embezzling $40,000 from the organization. Sentencing is pending in her case.

The majority of the patients coming to the behavioral clinic were on Medicaid and the executive director was responsible for managing the billings, according to statements in court and the billing paperwork. In New Jersey, there are rules about who can provide mental health services to Medicaid patients. Anyone providing mental health therapy through the program has to be properly licensed or maintain a master’s degree in mental health.

According to the Medicaid fraud lawsuit, multiple unqualified staff members treated Medicaid recipients and then the executive director Medicaid was billed anyways. The director himself also admitted to treating patients getting Medicaid benefits even though he was not properly licensed.

In addition to using unlicensed and untrained staff, the nonprofit allegedly billed Medicaid for therapy that never happened and used group therapy to bill as individual sessions, which is also against the billing rules. If a mother came in to receive a session on her own, both the mother and the child were billed for it as if they were both in attendance. Shorter sessions were also billed as longer and false records were used to pass Medicaid audits.

Medicaid fraud was only a part of the allegations against the nonprofit’s director — he also embezzled money from the company bank account to spend the money on him and his family, including travel, meals, and dental care, according to court documents.

Employees who didn’t show up for work were documented as “paid” with cash and payroll checks out of the nonprofit’s bank account. According to court documents, the money was in fact withdrawn from the company account to gamble at a casino. Allegedly, the amount of the embezzled funds totaled more than $1.5 million.

Medicaid fraud is often brought to the attention of the authorities through a “whistleblower,” or an employee who becomes aware of the fraudulent behavior. In an effort to identify cases of Medicaid and Medicare fraud, the federal government provides protections for whistleblowers who come forward with information on these kinds of cases.

If you think you need protection with regard to potential Medicaid fraud, contact the lawyers at Bradley/Grombacher today.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.