Florida's Attorney General is trumpeting two arrests related to what her office calls "Medicaid provider fraud."
"This fraudulent billing scheme not only defrauded the Florida Medicaid program out of more than $1.6 million but did so at the expense of Medicaid-dependent recipients, one being a disabled child," said Attorney General Ashley Moody.
"In addition to manipulating the system for extra money, the hiring of unqualified and unlicensed medical staff resulted in poor treatment and medical emergencies for Medicaid patients. I'm grateful for our Medicaid Fraud Control Unit (MFCU) for putting a stop to this scheme."
The AG's Office alleges Latrena Marie Thomas, the owner of the Northeast Florida based A River's Journey, hired "non-licensed individuals to provide hands-on personal care services to Medicaid recipients."
"In addition, Thomas paid Donald Ray Adams II, a parent of a disabled Medicaid recipient, to provide medically licensed care for his own child. In total, Thomas fraudulently billed Medicaid claims for 30 distinct medically needy Medicaid recipients, which caused a total loss of more than $1.6 million."
The scheme allegedly played out with unlicensed and poorly-vetted certified nursing assistants or home-health aides providing "hands-on personal care to Medicaid recipients."
"Several of these unqualified employees would have failed the Level 2 background screening that is required by the Florida Agency for Health Care Administration. Thomas did not have a Director of Nursing on staff to provide oversight of the licensed practical nurses and other staff employed by A River's Journey," the allegation continues.
"Thomas also falsified the agency's employee roster, progress notes, service logs and plan-of-care documents, and billed for a recipient's 24/7 nursing care while paying Adams. Thomas's negligent assignment of unqualified staff to recipients created three separate medical emergencies, including a trach tube dislodging, extreme sunburn and a delay in contacting Emergency Medical Services."
Alleged co-conspirator Adams is accused of "providing unsigned progress notes for his own child's care" in exchange for "cash, gift cards and bank deposits" totaling $7,320.
Thomas faces one count of Medicaid provider fraud of $50,000 or more, which is a first-degree felony charge. Adams is charged with a third-degree felony given the lesser amount.
The MFCU will prosecute the case through the State Attorney's Office for the Fourth Judicial Circuit.
In case all the qualifiers and careful wording throughout the article aren't clear enough, these are just charges as of now.
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