Cut and Paste

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Medical insurance application, silver pen and stethoscope. Legal law contract and health insurance concepts.

Billing fraud is very common within government healthcare programs. It usually happens when an approved provider submits fake invoices for goods or services that were never provided. Such is the case for Marty T. Johnson, 59, of Shreveport, La., and Keesha Dinkins, 45, of Bossier City. The two conspired to commit healthcare fraud and wire fraud through Johnson’s Positive Change Counseling Agency (Positive Change), resulting in a loss of $3.5 million to the Medicaid Program. (That’s certainly no small sum and I would say it is quite negative.)

Under Johnson’s ownership, Positive Change provided mental health rehabilitation and other related services to Medicaid beneficiaries in the parishes of Caddo and Bossier between 2014 and January 2018. During the same time, Dinkins was a manager and supervisor for the mental health practice.

Johnson submitted and caused fraudulent claims for mental health rehabilitation and non-emergency transportation services to be submitted to Medicaid. Dinkins was aware that Johnson submitted these fake claims, and she also knew that the services claimed had not been provided or rendered. (Essentially, she was guilty by association. She let it happen.)

You can’t have a scam if you don’t have any victims. Johnson paid individuals money to enroll with Positive Change so he could bill Medicaid for services that were not provided. Johnson told his employees, whom Dinkins supervised, to create fake client files to hide the fact that no services related to the claims had been provided. (They were hoping to conceal this from Medicaid, insurance company auditors, and inspectors.)

The two went to great lengths to create the fake client files to further their scheme. They instructed employees to cut out inserts from other client records and glue them into blank client log templates, which were then photocopied to make them look like legitimate documents. (That could pose a problem if an auditor asked for the originals.)  

Johnson also knowingly caused Positive Change to use the names and identification information of Medicaid recipients without their knowledge or consent. He used the data to submit fake claims for mental health rehabilitation and non-emergency transportation.

Marty Johnson and Keesha Dinkins pleaded guilty to federal charges related to healthcare fraud, which bilked the Medicaid Program out of $3.5 million. When sentenced, Johnson faces a maximum of 5 years in prison, 2 years of supervised release, and a fine of up to $250,000. Dinkins could be sentenced to a maximum of 3 years behind bars, 1 year of supervised release, and a fine of up to $250,000.

This case serves as a reminder that if you see something, say something. If you have any information regarding any type of Medicaid fraud, please contact the U.S. Department of Health and Human Services – Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477).

Today’s Fraud of the Day comes from a Department of Justice press release, “Owner of Counseling Agency and Supervising Manager Plead Guilty to Conspiracy to Commit Healthcare Fraud Charges,” dated October 26, 2021.

SHREVEPORT, La. – Acting United States Attorney Alexander C. Van Hook announced that two individuals have entered guilty pleas before United States District Judge Donald E. Walter in connection with a conspiracy to commit healthcare fraud and wire fraud.

Marty T. Johnson, 59, of Shreveport, Louisiana and Keesha Dinkins, 45, of Bossier City, each appeared in United States District Court on October 25, 2021 and pleaded guilty to federal charges. Johnson pleaded guilty to a Bill of Information charging him with conspiracy to commit healthcare fraud and wire fraud. Dinkins pleaded guilty to a Bill of Information charging her with misprision of a felony charge of healthcare fraud. Johnson and Dinkins each admitted to defrauding the Medicaid Program out of $3.5 million.

 

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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.