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Wednesday, December 21, 2011

Medicaid Fraud Is Rampant

And right in our back yard.

From the office of Attorney General Ken Cuccinelli:
Former office manager for personal care agency pleads guilty to Medicaid fraud
Agnes Vint admits to making false statements in relation to healthcare matters

Roanoke, VA (December 20, 2011) -- A former office manager at Health Care Virginia (HCVA) pled guilty to defrauding Medicaid yesterday in the United States District Court for the Western District of Virginia in Roanoke.

Agnes Underwood Vint, 75, of Selma, Va., along with others, were indicted by a Federal grand jury in March on a number of healthcare fraud related charges. This afternoon, Vint pled guilty to one count of making false statements in writing relating to healthcare matters.

"This case sends a strong message that providers who falsify official documents in a federal health care benefit program such as Medicaid or Medicare will be vigorously prosecuted," United States Attorney Timothy J. Heaphy said today. "This is the type of fraud that wastes our precious health care dollars. Ms. Vint has been appropriately brought to justice for her criminal activity."

"Vint was part of a scheme that not only defrauded Medicaid patients and taxpayers, but it also potentially put infirmed patients in extreme danger. She even falsified documents to state that patients were getting required nursing visits when they were not. I am just grateful that our investigators were able to stop such a cold and heartless act," said Attorney General Ken Cuccinelli.

HCVA, based in Covington, Va. was incorporated in 2007 for the purpose of providing personal care services and respite services to Medicaid recipients in the Western District of Virginia. HCVA entered into a Home and Community Based Personal Care Services Participation Agreement with the Department of Medical Assistance Services (DMAS) to become a Medicaid Provider in 2007. DMAS requires that all Personal Care Aides receive a minimum of 40 hours of training prior to employment, which must be taught and supervised by a registered nurse. DMAS also requires that all patients receive periodic nursing visits to verify patient safety and the continuing need for services.

Today in District Court, Vint admitted that while serving as the office manager at HCVA, between March 2008 and March 2010, she issued false training certificates in order to cover-up the lack of training received by Personal Care Aides assigned to Medicaid patients. She also admitted falsifying Nursing Assessments to cover up the fact that the HCVA nurse, co-defendant Sandra Pope, the owner and sole RN employed by HCVA, failed to make the required visits.

Under the direction and control of Pope, HCVA did not provide the required training of Personal Care Aides. Instead, Pope and HCVA issued false training certificates and assigned those Personal Care Aides to care for Medicaid patients in their homes.

As a result, from October 2007 through June 2010, HCVA billed and was paid over $980,061.21 in Medicaid funds for non-certified, untrained Personal Care Aides placed with Medicaid patients.

The other defendants charged with being part of the scheme, Sandra Pope McElwain, Melissa Cary and Health Care Virginia Inc. (HCVA) have each already pled guilty to similar charges. HCVA has been sentenced to three years probation, a fine of $10,000 and ordered to pay $323,420 in restitution.

The investigation of the case was conducted by the Department of Health and Human Services, Office of Inspector General, the Medicaid Fraud Control Unit of the Office of the Attorney General of Virginia, and other members of the Western Virginia Health Care Fraud Task Force. Assistant United States Attorney Jennie L. M. Waering and Assistant Attorney General and Special Assistant United States Attorney Vaso Doubles are prosecuting the case for the United States.
So much money. So little oversight.