Carr: Georgia Medicaid Fraud Control Unit Participates in National Healthcare Fraud Takedown

June 28, 2018

ATLANTA, GA – The United States Department of Justice and the Department of Health and Human Services just announced the largest ever healthcare fraud enforcement action by the Medicare Fraud Strike Force, involving 601 charged defendants and more than $2 billion. As part of the National Healthcare Fraud Takedown, the Georgia Medicaid Fraud Control Unit (MFCU) coordinated its efforts with multiple federal agencies. These activities spanned all three federal districts located in Georgia and included collaborations with the United States Attorneys’ Offices, the Department of Health and Human Services Office of the Inspector General(HHS – OIG), the Federal Bureau of Investigation (FBI) and the Drug Enforcement Administration (DEA).

“Our Medicaid Fraud Control Unit is committed to protecting the integrity of the Georgia Medicaid program, its members and the taxpayer dollars used to provide this service,” said Attorney General Chris Carr. “We will remain vigilant in our efforts to uncover any fraud or abuse in the program and aggressively work to  recover any and all funds spent illegally. The ability to combine our resources with those of our federal partners is a powerful tool in this on-going fight.”

Georgia MFCU Enforcement actions include the following:

United States v. Frank H. Bynes, Jr. – In June 2018, Savannah area physician Frank H. Bynes, Jr. was indicted on numerous counts of Unlawful Dispensation of a Controlled Substance and Healthcare Fraud in the Southern District of Georgia. According to the Indictment, Bynes issued thousands of prescriptions for narcotics and other powerful opioids and pain killers without a valid medical purpose. In some situations, Bynes also engaged in unprofessional conduct with female patients in relation to these prescriptions. The investigation was handled by DEA Task Force Officer Angelia Coleman and HHS Special Agent T.J. Smith with assistance from Georgia MFCU Investigator Kevin White and Investigative Auditor David Clark. The case is being prosecuted by Assistant U.S. Attorney Tom Clarkson and Assistant Attorney General Jim Mooney.

United States v. Rosa Fitzhugh aka Rosa Leger aka Rosa Cedeno – Rosa Fitzhugh was indicted by a Federal Grand Jury in the Northern District of Georgia on charges of Conspiracy to Commit Health Care Fraud, and Aggravated Identity Theft on June 28, 2018. The indictment alleges that Rosa Fitzhugh, through her business Casa Luisa, hired Licensed Care Professionals to “review notes” in order to gain access to their provider numbers for billing. Fitzhugh had been previously terminated from working as a provider in 2014 for failing to provide services billed. In the current scheme Fitzhugh would send contractors out to homes of children for tutoring and after school type activities but billed for individual psychotherapy and other services that could not be provided in the manner in which they were billed. The parents of the recipients were unfamiliar with any of the LPC’s. The investigation was conducted by Investigator Sadarius Miley of the Georgia MFCU and several other MFCU Investigators. The case is being prosecuted by Assistant U.S. Attorney Jeff Brown of the Northern District  and Assistant Attorney General Elizabeth Grofic of the Georgia MFCU.

State of Georgia v. Paula Houston and Otis Nettles – Paula Houston and Otis Nettles were indicted by a Cobb County Grand Jury on charges of Medicaid Fraud, Conspiracy to Defraud the State, and False Writings on May 31, 2018. The indictment alleges that Houston and Nettles submitted claims through Acumen for hours for caregiver services that were not provided. The scheme involved submitting hours worked for a former caregiver as well as a person who was never hired as a caregiver. The investigation was conducted by Investigator Sadarius Miley of the Georgia MFCU. The case is being prosecuted by Assistant Attorney General Elizabeth Grofic of the Georgia MFCU.

United States v. Douglas Moss and Shawn Tywon – In May 2018, Valdosta area physician Douglas Moss and physician’s assistant Shawn Tywon were indicted in the Middle District of Georgia on charges of Conspiracy to Commit Healthcare Fraud and Healthcare Fraud. According to the Indictment, between January 2012 and December 2014, Moss and Tywon caused the submission of more than 30,000 claims for nursing home services to the Medicare and Georgia Medicaid program. Many of these services were not medically necessary or were not performed as billed. The investigation was handled by Investigator Trent Williams and Investigative Auditor Denise Colson of the Georgia MFCU along with HHS Special Agents Jeremy Jefferson and Michael Britton and FBI Special Agent Brett McDaniel. The case is being prosecuted by Assistant U.S. Attorney Sonja Profit and Assistant Attorney General Jim Mooney.

United States and State of Georgia v. Miracle Home Care, Inc., et al. – In June 2018, the U.S. Attorney’s Office for the Southern District of Georgia and the state of Georgia filed a civil False Claims Act complaint against Miracle Home Care, Inc., Miracle Adult Day Care, Inc., Miracle Transport and business owner Shashicka Tyre-Hill. The complaint alleges that the Miracle entities, with the knowledge of Hill, submitted millions of dollars in false or fraudulent claims for adult day health and non-emergency transportation services to Georgia Medicaid. According to the complaint, many of the services billed never occurred. The investigation was conducted by HHS Special Agent David Graupner, U.S. Attorney’s Office Investigator Kim Reinken and Georgia MFCU Investigator Sadarius Miley and Investigative Auditor Maria Anam. Assistant U.S. Attorney Jonathan Porter and Assistant Attorney General Jim Mooney are representing the government.

Settlement with Antioch Medical Associates, P.C. and Dr. J. Alphonso Dandy – In June 2018, the U.S. Attorney’s Office for the Southern District of Georgia and the state of Georgia finalized a settlement for $739,711.15 with Savannah area podiatry practice Antioch Medical Associates, P.C. and its owner Dr. J. Alphonso Dandy. The settlement resolves potential claims against Antioch for the submission of medically unnecessary nail debridements to Medicare and Georgia Medicaid along with improperly billing other office visits in violation of program rules. The investigation was conducted by HHS Special Agent T.J. Smith, U.S. Attorney’s Office Investigator Kim Reinken and Georgia MFCU Investigator Kevin White and Investigative Auditor Denise Colson. Assistant U.S. Attorney Jonathan Porter and Assistant Attorney General Jim Mooney represented the government.