General · December 2, 2020 0

Atlanta: Diandra Bankhead sentenced for defrauding Georgia Medicaid

Home health care owner, Diandra Bankhead sentenced to more than five years for defrauding Georgia Medicaid

ATLANTA (STL.News) Diandra Bankhead, the owner and operator of Elite Homecare (“Elite”), an Atlanta-based home healthcare provider, has been sentenced for defrauding Medicaid out of nearly $1 million.  Between September 2015 and April 2018, Bankhead submitted thousands of fraudulent claims for services that were never provided to medically fragile children under the Georgia Pediatric Program (“GAPP”).

“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung J. “BJay” Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”

“Bankhead’s greed-fueled scheme, designed to enrich herself, came at the expense of disabled children and taxpayers.  Instead she faces years of imprisonment – a fate awaiting those stealing Medicaid funds,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.  “Working closely with our State and Federal law enforcement partners we will bring to justice those who illegally drain this vital program.”

“Bankhead’s lack of concern for the needs of fragile children to profit rather than care for them is very troubling, and now she must pay the price for her greed,” said Chris Hacker, Special Agent in Charge of FBI Atlanta.  “Not only did she deny care to children in need, she also stole taxpayer dollars from a Medicaid program that should have gone to those who need them.”

“Our Medicaid Fraud Division, in cooperation with our state and federal partners, will remain vigilant in maintaining the integrity of public programs and prosecuting those who take advantage of them,” said Attorney General Chris Carr.  “This case is especially egregious as it involves someone purporting to help serve children in need all the while neglecting their responsibility to devote these funds for those purposes.  This behavior is unacceptable.”

According to U.S. Attorney Pak, the charges and other information presented in court: GAPP is an in-home nursing program designed to serve Medicaid-eligible children under the age of 21 years of age based on a medical necessity. The program offers in-home skilled nursing services for medically fragile children who require nursing services, and personal care services, including feeding, bathing, dressing, personal hygiene, preparation of meal, and assisting with the mobility and ambulation of members.

Medically fragile children who are eligible for services under GAPP typically suffer from significant physical and cognitive disabilities, including autism, blindness, cerebral palsy, Down syndrome, epileptic seizures, and/or paralysis.

Bankhead’s scheme began in September 2015 and continued until April 2018.  Over that time, Elite Homecare submitted more than 5,400 claims to Georgia Medicaid—the vast majority of which were fraudulent—and for which Elite received $1.2 million in reimbursement.  Bankhead defrauded Medicaid in a number of ways, including:

  • Submitting fraudulent credentialing information to the State of Georgia Department of Community Health in order to become a certified GAPP provider, including falsely representing that a registered nurse (“RN”) —without her knowledge or authorization—served as Elite’s RN Supervisor.
  • Falsely representing to Medicaid that an RN or RN Supervisor had conducted the initial evaluation of putative GAPP members as required by applicable regulations.
  • Submitting fraudulent claims for in-home nursing services allegedly provided to families who had not retained Elite to provide any services.
  • Submitting fraudulent claims in which Elite employees allegedly provided more than 24 hours of services in a given day.
  • Submitting fraudulent claims where Elite employees were impossibly providing services to multiple children simultaneously.
  • Submitting fraudulent claims in the names of multiple individuals, including RNs, who did not provide the services in question, and did know that their identities and credentials were being used.
  • Submitting fraudulent claims that had been “upcoded” – that is claims which fraudulently increased the amount Medicaid paid Elite – by materially misrepresenting the level of care provided and the level of licensing for the individual allegedly providing the services. For example, Elite submitted fraudulent claims to Medicaid purporting that an RN (billed at $40/hour) had rendered the services when in fact an licensed professional nurse (billed at $30/hour) and/or personal care service provider (billed at $20/hour) had actually done so.
  • Preparing fraudulent supporting documentation for the in-home nursing services that were never provided, including fraudulent patient care charts.

Among the fraudulent claims that Bankhead submitted to Georgia Medicaid for services that were never performed were for services allegedly provided to an infant girl after she had passed away and three children, all under the age of thirteen, who suffered from cerebral palsy or Downs Syndrome.  These children were entirely dependent on others to complete the most basic tasks of life—feeding themselves, clothing themselves, bathing, and even standing up to walk.

In addition to the underlying fraud, Bankhead also failed to truthfully and completely disclose her finances to the United States Probation Office as required by her plea agreement.  Rather, the information presented at sentencing established that Bankhead entered into a kickback arrangement with another Atlanta-based home health provider under which she “sold” twenty of Elite’s former clients in exchange for receiving a percentage of the Medicaid billings tied to those clients going forward.  Such arrangements are generally unlawful under the federal Anti-Kickback Statute.

Bankhead, 43, of Atlanta, Georgia was sentenced by U.S. District Court Judge Thomas W. Thrash, Jr. to five years and three months in federal prison, and three years of supervised release, and ordered to pay $999,999, in restitution. On August 28, 2019, Bankhead pleaded guilty to a criminal information pursuant to a written plea agreement charging her with one count of health care fraud.

This case was investigated by the Department of Health and Human Services, Georgia Medicaid Fraud Control Unit, and Federal Bureau of Investigation.

Assistant U.S. Attorney Alex R. Sistla prosecuted the case.

SOURCE: USDOJ.Today

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