On Tuesday, September 24, 2013, the Muscogee County Grand Jury returned an indictment against Della Upshaw for two counts of Medicaid Fraud (O.C.G.A. § 49-4-146.1(b)) for making false claims to Georgia Medicaid.

Upshaw is the owner of Senior Care of Columbus, Inc., and Reaching Out Healthcare, Inc. The companies were enrolled in the Community Care Service Program, a Medicaid program administered by the Georgia Department of Community Health, for senior citizens in need of assistance, including in-home personal care and day health services.

The indictment alleges that from 2009 until 2011, Upshaw submitted numerous fraudulent claims for and was reimbursed for services that were not provided to patients. An investigation began when it was discovered that Upshaw submitted an extraordinarily high percentage of claims for reimbursement to Georgia Medicaid without any documentation. The investigation revealed that in many instances, Upshaw billed Medicaid on days when patients received no services at all. She also billed for patients who had been discharged. This alleged scheme resulted in over $269,000 in payments to which she was not entitled.

Assistant Attorney General Henry Hibbert is prosecuting the case on behalf of the State of Georgia. Investigator Ralph Harper, Investigator Judy Cooper, Chief Nurse Investigator Donna Wills and Intelligence Analyst Zwella Boyd, of the Attorney General’s Medicaid Fraud Control Unit, investigated the case with the assistance of the Department of Community Health Office of the Inspector General.

The indictment is attached.

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