Standing in the GAPP

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Man giving bribe to a doctor

There’s nothing more appalling in the home healthcare industry than a provider who takes advantage of vulnerable patients, particularly children. Today’s “Fraud of the Day” details the alarming actions of Medicaid fraudster Diandra Bankhead, the former owner-operator of Elite Homecare in Atlanta, Ga. She received $1.2 million in reimbursements from Medicaid for submitting thousands of fraudulent claims on behalf of medically fragile children. (She should have been standing in the gap so her victims could receive the care they qualified for and deserved.)

In Georgia, medically-qualified children such as those who are autistic, blind, or having disabilities like Down Syndrome or Cerebral Palsy, can get much-needed help under the Georgia Pediatric Program (GAPP). GAPP typically helps qualified special-needs kids and youth with nursing and home health needs such as feeding, bathing, dressing, and meal preparation. (This program provides a sorely needed lifeline to the most vulnerable among us, which makes this crime even more egregious.)

The scheme was straightforward in its underhandedness. For just over two-and-a-half years, Bankhead submitted more than 5,400 claims to GAPP for providing non-existent services. These illegal submissions ultimately diverted critical resources from those who needed them most. (It takes a pretty bold person to claim they are helping special-needs kids, when actually they were stealing from those kids and taxpayers, too.)

Bankhead submitted claims with falsified credentialing information stating that a registered nurse was the company’s nursing supervisor. (The nurse was unaware that her name and personal information had been used in this capacity.) Some of the fake claims also indicated that Elite employees provided more than 24 hours of services in a day or provided services to multiple children at the same time. (Obviously, that is physically impossible unless clones are involved.)

Bankhead also used her employees’ identities and credentials to file fraudulent claims. She made claims for in-home nursing services for families who did not even request such services, unbeknownst to them. (Well, if you have the brass to steal then mere lying is second nature.)

And if you thought it couldn’t get any worse, Bankhead claimed to provide care for a baby girl after she had passed away. (That’s heartless.)

The 43-year-old fraudster from Atlanta was sentenced to 63 months in federal prison and three years of supervised release. She also was ordered to pay nearly $1 million in restitution. (That almost seems fair but doesn’t account for the anguish caused by her fraudulent actions against Medicaid.) 

Today’s Fraud of the Day comes from a Department of Justice press release, “Home health care owner sentenced to more than five years for defrauding Georgia Medicaid,” dated December 2, 2020.

ATLANTA –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.”

 

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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.