Pinky Promise

Close-up Of A Doctor's Hand Analyzing Report On White Desk

When Medicaid providers accept new patients, they essentially make a promise to provide good care and to protect their healthcare records and personally identifiable information. While the operators of two businesses in Bridgeport, Connecticut that offered social and psychotherapy services to their patients appeared to act in good faith, they made a pinky promise to each other to defraud not only their patients, but also licensed healthcare providers in a $2.5M Medicaid fraud scheme.

The Bridgeport-based business operators used the two locations to bill Medicaid for psychotherapy services that were never provided. (That’s a common way that many providers defraud the government healthcare program.) The deceptive duo went as far as to use the Medicaid provider number of two licensed healthcare providers to carry out their scheme. (These two healthcare providers had never provided or supervised any psychotherapy services as billed to Medicaid.) One of the operators lifted the providers’ Medicaid numbers at the Connecticut Department of Mental Health and Addiction Services (DMHAS) where all three of them worked. (Obviously, the two providers had no idea that their Medicaid provider numbers were being used to submit fraudulent claims.)

Another co-conspirator who was employed by an organization that provided substance abuse treatment provided personally identifiable information of her employer’s patients to keep the Medicaid fraud scheme running. She supplied Medicaid identification numbers, Social Security numbers and birthdates. (Together, the trio submitted claims for approximately 150 patients and successfully received payment for about 75 of them. And, I might add that none of the services billed for were provided.)

One operator, the 50-year-old woman who stole the Medicaid provider numbers, pleaded guilty to healthcare fraud. The former state employee was sentenced to two years in prison to be followed by three years of supervised release. She must also pay $2,496,618 in restitution to Medicaid.

The other operator also pleaded guilty to healthcare fraud in today’s fraud case and in another separate Medicaid fraud case. (She was a busy lady.) The woman who stole the Medicaid numbers of patients pleaded guilty to healthcare fraud and identity theft. The two accomplices are both awaiting sentencing. Today’s fraud article also states that another five individuals have been charged and convicted on healthcare fraud offenses related to the Connecticut case and related investigation.

This Medicaid fraud case is a prime example of what happens when deceptive providers go back on their promise to provide exceptional care to their vulnerable patients. The government most definitely promises to go after those who go back on their promises. (You can pinky swear on that.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, “Former State Employee Sentenced to Prison for Role in Medicaid Fraud Scheme,” released on May 30, 2019.

John H. Durham, United States Attorney for the District of Connecticut, announced that TOSHIREA JACKSON, 50, of Bridgeport, was sentenced today by U.S. District Judge Victor A. Bolden in Bridgeport to 24 months of imprisonment, followed by three years of supervised release, for her role in a health care fraud scheme.

According to court documents and statements made in court, beginning in January 2012, Jackson and Juliet Jacob operated two businesses, Transitional Development And Training (TDAT), and It Takes A Promise (ITAP), both located at 360 Fairfield Avenue in Bridgeport, which provided social and psychotherapy services.  The investigation revealed that Jackson and Jacob used ITAP and TDAT to bill Medicaid for psychotherapy services that were never provided.  As part of their scheme, Jackson and Jacob used the Medicaid provider numbers of two licensed health care providers who had neither rendered nor supervised any of the psychotherapy services that Jackson and Jacob billed to Medicaid.  Jackson, and the two licensed providers, were employees of the Connecticut Department of Mental Health and Addiction Services (DMHAS).  The two providers did not authorize Jackson or Jacob to obtain provider numbers for them at TDAT or ITAP, and were not aware that TDAT or ITAP were billing Medicaid as if the providers had personally rendered the psychotherapy services.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.