With Open Arms

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A Glen Allen, Virginia woman is the focus of today’s “Fraud of the Day” article for opening her arms wide to fraud. While the connotation of open arms means that someone or something is welcomed and accepted, this Richmond-area owner of three family counseling services companies opened her arms to patients specifically for the purposes of carrying out a Medicaid fraud scheme.

Ironically, the Glen Allen woman owned three medical support service companies that all had “Open Arms” as part of the company name. The article alleges that the owner ran multiple fraud schemes over a seven-year period. Some of those schemes involved submitting Medicaid claims for services that were never provided; paying kickbacks to increase client referrals; and submitting claims for services that were provided to ineligible recipients. (Sounds like she had all her bases covered.)

These schemes may have gone on if it were not for an employee who decided to voice her disagreement with company billing practices. A complaint was filed by the former therapeutic day treatment center counselor who was wrongfully terminated. (While the whistleblower was punished for opening her mouth and not participating in the fraudulent billing practices, a pretty nice reward came later in exchange for her honesty.)

Under the whistleblower provisions of the federal False Claims Act and the state Virginia Fraud Against Taxpayers Act, a lawsuit was filed against the owner of the trio of Open Arms branded companies. Long story short, a settlement was approved between the 43-year-old owner and her Richmond-area companies. She agreed to pay a $1 million judgement and to be banned from the Virginia Medicaid Program for life. (Terms of the settlement call for an initial payment of $50,000 and a consent judgement of $1,061,613 to resolve the civil complaint.)

Court records show that this was not the woman’s first brush with the law. It turns out that in a separate case, the company owner had previously pleaded guilty to theft from a healthcare benefit program. (You don’t say. Somehow, that doesn’t surprise me at all.) That case involved kickbacks and a business that sold handicap-accessible vehicles to the Virginia Birth-Related Neurological Injury Compensation Program.

One bright spot in this case is that the whistleblower received a share of the money recovered by the federal and state governments. The former employer, who stood up for what was right, received 18 percent of the money paid by the defendant. (I bet she welcomed that check with open arms.)

Today’s “Fraud of the Day” is based on an article entitled, “Health care provider agrees to ban from Medicaid program and $1 million settlement,” published by Richmond Times-Dispatch on July 3, 2018.

Civil fraud allegations against a Glen Allen woman and her Richmond-area medical support companies have been settled in a $1 million judgment and a lifetime ban from the Virginia Medicaid Program.

The settlement was approved Tuesday by U.S. District Judge Henry E. Hudson between Dawn Sykes, 43, and the federal and state governments.

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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.