With each story about health care fraud that the Allegiant Experts Blog analyzes, it demonstrates the growing number of fraudsters who are brought to justice. We suppose that’s a good thing, of course. However, the spike in justice being served doesn’t seem to deter those who continue to wish to defraud our nation’s health care insurance programs.

Last week, our blog reported on one of the largest health care fraud schemes ever. It involved charges being laid against 35 different individuals who participated in a fraudulent genetic testing scheme responsible for over $2.1 billion in losses. As you may have guessed, the story we’re analyzing this week further proves the lengths people will go to commit health care fraud.

Six people from Ohio pleaded guilty to a large health care fraud scheme.

As reported by the Northern District of Ohio branch of the United States Department of Justice, “six people from Ohio pleaded guilty in federal court to crimes related to a health care fraud conspiracy in which Medicaid was billed $48 million for drug and alcohol recovery services, many of which were not provided, not medically necessary, lacked proper documentation, or had other issues that made them ineligible for reimbursement.”

Those six people are Ryan P. Sheridan, Jennifer M. Sheridan, Kortney L. Gherardi, Lisa M. Pertee, Thomas Bailey and Arthur H. Smith. They are all expected to be sentenced in January 2020.

Sheridan owned several recovery centers for drug and alcohol abusers.

According to the court documents, the 39 year-old Sheridan owned Braking Point Recovery Center, among other businesses such as recovery houses for those battling drug and alcohol abuse. His drug and alcohol rehabilitation centers in Austintown and Whitehall, Ohio provided detox, intensive outpatient treatment, day treatment and residential living rehabilitation.

Sheridan is a certified provider. As a result, he agreed to follow the rules and regulations of the Ohio Medicaid Program and the Ohio Department of Mental Health and Addiction Services. However, between January 2015 and October 2017, numerous fraudulent billings for drug and alcohol services were submitted to Medicaid.

The DoJ report notes there were multiple issues with these billings.

Among them was the fact the billings were coded to reflect a service more costly than was actually provided, without proper documentation and without proper assessment documents containing valid diagnosis. The 45 year-old Bailey, who was also charged in this case, had some of the billings related to him. They included the dispensing of Suboxone (which is used to treat dependence on opioid drugs) even though Bailey did not have the authority to do so. These violations only scratch the surface of the charges laid.

All in all, Braking Point submitted approximately 134,744 claims to Medicaid for a total of over $48.5 million in services. The billings were for services purported to be provided between May 2015 and October 2017, resulting in payouts of more than $31 million. Medicaid suspended payments to Braking Point on October 18, 2017, reports the DoJ.

Are you an attorney who is currently trying a health care fraud case?

Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help your case. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.