Georgia has a very generous Medicaid program that allows eligible people with developmental disabilities to receive home care. Called the Comprehensive Supports Waiver Program (COMP), folks who are too ill to fully care for themselves can have a family member stay home and provide for them.
If you are thinking the COMP program is rife with fraud, you are correct. All over the country, Medicaid officials struggle with home care programs. Lawmakers want eligible patients to be comfortable in their own homes and get the care they need. Often the best care comes from family members. Unfortunately, some family members look at these programs as cash cows.
Deonn Carter’s Tragic Life
Until he died from complications of a gunshot wound, Deonn Carter struggled with life. The 31-year-old autistic man was still fortunate, however. Despite his disability, he was able to work part-time at a neighborhood Piggly Wiggly grocery store as a bagger. Everyone who shopped there knew him and loved him.
Unfortunately, Deonn’s life was cut short when he was shot while getting his mother’s mail at an apartment they shared. In the aftermath of the shooting, investigators learned that Deonn wasn’t getting the care he deserved. Care provided by his sister and paid with tax dollars.
Mother, Sister Indicted for Medicaid Fraud
On December 28th, Deonn’s mother, Suzette Ragland, and his sister, Kimillia Carter, were arrested and charged with Medicaid fraud. Investigators had pieced together some 1300 hours that Kimillia claimed that she had provided home health care to Deonn. Instead, prosecutors say she was busy working at another job.
Deonn’s mother was charged because she was his legal representative and had designated her daughter to be the caregiver. She also signed off on time sheets prepared by the daughter and sent them in for reimbursement. According to the indictment, “By submitting these falsified time sheets, Suzette Ragland and Kimillia Carter caused numerous fraudulent claims for medical assistance to be submitted to Georgia Medicaid through Acumen for services that were not provided.” Acumen is a third party contractor that administers and pays Medicaid vendors in Georgia.
If convicted, both woman face one to five years in prison and must pay restitution. Even if she didn’t receive any money Ragland can still be on the hook for her alleged participation in the scheme. [The charges are allegations at this point. All defendants are presumed innocent until proven guilty.]
This case is tragic in so many ways. Unfortunately, it is also common.
While alive, Deonn Carter was deprived of the care he deserved. Folks with developmental disabilities are often quite vulnerable. Rather than have them live in institutions, Georgia lawmakers allows family members to provide care. If the allegations of this case are true, Deonn was deprived of that care.
Medicaid Fraud Hurts Taxpayers
Medicaid is funded with tax dollars. When someone commits Medicaid fraud, they hurt everyone who pays taxes. They also hurt the Medicaid system. Designed to be the caregiver of last resort, Medicaid is woefully underfunded in most states. Often there are waiting lists for care. Therefore anyone who steals from Medicaid hurts all those in need and waiting for help.
Whistleblower Awards for Medicaid Fraud Information
The federal government and 29 states have award programs for people who bravely report Medicaid and Medicare fraud. Called False Claims Acts, these laws allow insiders with information about tax funded healthcare fraud to claim awards. The awards are typically 15% to 30% of whatever is recovered from wrongdoers.
Generally, only the first person to report is entitled to share in any recovery.
Reporting is done by filing a sealed lawsuit in either state or federal court. Where the claim is filed depends on whether the fraud involves Medicaid or Medicare.
Interested In Receiving Your Own Whistleblower Award?
The whistleblower lawyers at MahanyLaw have helped their clients receive over $100 million in awards. For more information, visit our Medicaid and Medicare fraud information page. Better yet, give us a call. All inquiries are protected by the attorney – client privilege and kept confidential. There is never a fee or costs unless we first recover money for you.
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