Unhelpful Helping Hands

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Computer security concept

The Helping Hands Academy in Connecticut was supposed to provide applied behavior analysis for children diagnosed with Autism Spectrum Disorder (ASD). Instead, the business owner and a phony “behavior analyst” conspired to defraud Medicaid (while victimizing families and patients with subpar services).

Medicaid requires that treatment for ASD be overseen by a licensed medical practitioner or a Board Certified Behavior Analyst. Filling that requirement was Jessica Stuart, who collected at least $143,000 from the Academy for her services (more like dis-service!) and racked up $369,439.96 in fraudulent claims as a result. Stuart is not a BCBA or licensed medical practitioner, doesn’t have a college degree, and lacks any formal training in applied behavior analysis for ASD. (But she is one swell swindler!)

Stuart committed identity theft by using the name and license information of a legitimate BCBA. She pleaded guilty to health care fraud and identity theft. Nicole Balkas, the owner of the businesses, also pleaded guilty to healthcare fraud.

The devious duo carried out the Medicaid scheme for two years. Among other fraudulent activity, they submitted claims for dates of service when no services were provided to the patients listed on the claims. They also inflated hours of service when services had been provided. (If you want to call what was provided by a completely unqualified charlatan “services”.)

Medicaid terminated the company as a Connecticut provider in 2020, prompting Balkas to lie (it came naturally for her) and submit altered documents in an attempt to rescind the termination and be paid for more fraudulent claims. Balkas’ actions caused Medicaid to lose more than $551,000, for which she could face up to 10 years in prison. She will also be ordered to make full restitution. Stuart could face up to ten years in prison for the healthcare fraud, and up to 15 years for using false identification in connection with healthcare fraud. (Hopefully, the court will give these con-women lots of time to ponder the error of their ways.)

Today’s Fraud of the Day comes from a press release from the U.S. Attorney’s Office for the District of Connecticut, “Employee of Autism Services Agency Pleads Guilty to Health Care Fraud and Identity Theft Offenses,” dated June 2, 2021.

Leonard C Boyle, Acting United States Attorney for the District of Connecticut, announced that JESSICA STUART, 38, of Fairfield, waived her right to be indicted and pleaded guilty today before U.S. District Judge Jeffrey A. Meyer in New Haven to health care fraud and identity theft offenses.

According to court documents and statements made in court, Stuart was employed by Helping Hands Academy, LLC, in Bridgeport, which provided applied behavior analysis services to children diagnosed with Autism Spectrum Disorder (ASD).   Helping Hands Academy enrolled as a participating provider in the Connecticut Medicaid Program (“Medicaid”) in approximately September 2018.

Additional information comes from a Connecticut Post article, “Federal prosecutors: Bridgeport resident pleads guilty to health care fraud,” dated April 28, 2021.

 

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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.