Home Health Services Company Employee Pleads Guilty To Medicaid Fraud

COLUMBUS – Robin Pavey, 45, of Washington Court House, Ohio pleaded guilty in U.S. District Court to submitting $312,868 in fraudulent claims for home health care services for children to the Ohio Medicaid Program.

Carter M. Stewart, United States Attorney for the Southern District of Ohio, Lamont Pugh III, Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General, and Ohio Attorney General Mike DeWine announced the plea entered today before Senior U.S. District Judge George C. Smith.

According to testimony at the plea hearing, between August 2012 and March 2013, Pavey, who was employed by Healthy Solutions Home Health Services with offices in Washington Court House and Hillsboro, instructed parents whose children were receiving home health care services to “swap” time sheets with other parents who were providing home health care services to their own children.  It was part of the scheme that by swapping time sheets it would give the false appearance that parents were providing home health services to children other than their own.  Under the Medicaid Program, a home health aide cannot be the parent, foster parent, or legal guardian of a patient who is under 18 years old.

It was also part of the scheme that in order to maximize the amount of reimbursement paid by the Medicaid Program, Pavey instructed Healthy Solution nurses to submit Skilled Nursing Visit Notes that falsely inflated the number of hours that nurses were providing home health services.

Health care fraud is punishable by up to ten years in prison and a fine of $250,000. Peavey could also be sentenced to pay restitution.

Stewart commended Assistant United States Attorney Ken Affeldt, Special Assistant U.S. Attorney Constance Nearhood with the Ohio Attorney General’s Office and Assistant Ohio Attorney Geenral Maritsa Flaherty, who represented the United States in the case, and the cooperative investigation conducted by Health and Human Services Inspector General agents, and agents in Attorney General DeWine’s Medicaid Fraud Control Unit.

Ohioans can report suspected Medicaid fraud to Attorney General DeWine's office by calling 1-800-282-0515 or visiting www.OhioAttorneyGeneral.gov.

Individuals or health care company employees who suspect fraud against government health insurance programs can also report them anonymously online at www.stopmedicarefraud.gov, or by calling 1-800-HHS-TIPS (800-447-8477).