Medicaid Fraud Provider Plea
RALEIGH – Robert J. Higdon, Jr., United States Attorney for the Eastern District of North Carolina, announced that in federal court, United States Magistrate Judge Robert B. Jones, Jr. accepted a guilty plea in a health care fraud matter.
ANDREA BOATMAN HALL, now known as, ANDREA MONIQUE PURNELL, 32 years of age, from Sanford N.C., pled guilty to one count of Medicaid Provider Fraud.
The investigation revealed that PURNELL was the owner, operator, manager and/or CEO of Extended Reach Day Treatment for Children and Adolescents (”Extended Reach”), a Medicaid provider of behavioral health services, including “day treatment” services. From on or about October 1, 2013, through October 26, 2016, PURNELL engaged in a scheme to defraud Medicaid by “adding” units of Day Treatment services not actually provided to Medicaid recipients in Extended Reach’s billed claim submissions. These “added” units were added to those units of service that were actually provided to Medicaid recipients on a particular date of service. For example, a particular beneficiary may have been at Extended Reach for four (4) hours on a particular day, but the Defendant billed the maximum six (6) hours for the individual on that day. The defendant engaged in an extensive and systematic scheme to fraudulently bill “added” unit claims for “day treatment” services provided to Medicaid recipients.
Additionally, PURNELL engaged in a scheme to defraud Medicaid by billing for “day treatment” services allegedly provided to Medicaid recipients on dates of service when those recipients were absent, and where such services were not in fact provided. As such, these false claims differ from “added” claims because no “day treatment” services at all were provided to the Medicaid recipients on the alleged dates of service. These “absent” client billings include billings for clients who were simply absent on a particular billed day of the week (for example, if a client was only present on Monday, Wednesday and Friday of a week, the defendant would bill for services for every day of that week even when the client was absent); billing for clients who were physically present at and receiving services in some other facility that day (such as a psychiatric residential treatment facility), and; billing for services on days when the Extended Reach facility was actually closed – such as a snow day on February 17, 2015, and on Labor Day of 2014.
PURNELL also engaged in a scheme to bill for psychotherapy services as if they had been performed by a licensed medical doctor, when those services were not provided by the doctor for Extended Reach. Investigators interviewed the doctor and he informed the investigators that he did not perform psychotherapy services for Extended Reach.
The total fraudulent billing for all schemes is $372,917.74. The total loss amount due to Medicaid is $337,615.42.
United States Attorney Higdon commented: “Medicaid beneficiaries face complex and costly needs for care and rely on, and trust, their health care providers to provide quality care. This defendant violated their trust by using their information to unlawfully line her pockets with money. This should never happen. The USAO-EDNC will continue to thoroughly investigate and prosecute to the fullest those who commit health care fraud to unlawfully obtain money to which they are not entitled.”
The investigation of this case was conducted by the United States Department of Health and Human Services Office of the Inspector General, and the North Carolina Attorney General’s Office Medicaid Investigations Division. Special Assistant United State Attorney, Daniel Spillman, of the North Carolina Attorney General’s Office Medicaid Investigations Division, represented the United States.