top of page

South Carolina Woman Admits To Medicaid Fraud Involving ASD Services


Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that is characterized by a range of challenges. Those with ASD often contend with social communication issues, display repetitive behaviors and have restricted interests. The reason that autism is referred to as a “spectrum” disorder is because it can manifest in a wide variety of ways and with varying degrees of severity.


ASD affects individuals differently. No two people with autism are exactly the same. “People with ASD may also have different ways of learning, moving, or paying attention,” informs the Centers for Disease Control and Prevention, “It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging.”


People with ASD experience numerous challenges.


Social communication, in particular, is met with great difficulty. Those with ASD often have difficulties with understanding and using verbal and nonverbal communication. This can lead to challenges in forming and maintaining social relationships, as well as understanding social cues and emotions.


The CDC reveals a number of characteristics of those who have social communication challenges. They including avoiding or not keeping eye contact; not responding to name by 9 months of age; not showing facial expressions for any mood; not playing simple interactive games by 12 months of age; using few or no gestures by 12 months of age; and not singing, dancing or acting by 60 months of age.


Many individuals with ASD engage in repetitive behaviors or routines.


These might include repetitive body movements like hand-flapping, insistence on sameness, rigid adherence to routines or intense interests in specific topics. The CDC explains that those with ASD may show such behaviors as lining up toys or other objects and getting upset when the order is changed; repeating words or phrases over and over (this is called “echolalia”); and having unusual reactions to the way things sound, smell, taste, look or feel.


ASD therapy clinic owner pleads guilty to Medicaid fraud charges.


Last week, the District of South Carolina branch of the U.S. Attorney's Office reported that Nina Bourret pleaded guilty to making false and fraudulent statements on claims submitted to Medicaid. The 41 year-old resident of Greenville, South Carolina was an owner of Agapi Behavior Consultants, Inc. The clinic provided Applied Behavior Analysis therapy to treat Autism Spectrum Disorder.


According to evidence obtained in the investigation, Bourret submitted electronic claims to Medicaid on behalf of Agapi between February 2021 and December 2022. Those claims falsely and fraudulently certified that services had been rendered. They also certified that services had been rendered in excess of what was actually provided to the beneficiary. The bogus claims to Medicaid were in excess of $900,000.00.


“Bourret faces a maximum penalty of 5 years in federal prison,” reports the U.S. Attorney’s Office, “She also faces a fine of up to $250,000, restitution, and 3 years of supervision to follow the term of imprisonment.”


Are you an attorney who is currently working a healthcare fraud case?


The clinical experts at Allegiant Experts can help you! We coordinate and support courageous whistleblowers that shine lights on fraud, waste and abuse. Contact us today to schedule a complimentary consultation. Please don’t hesitate to give us a call at 407-217-5831. You may also email us at info@allegiantexperts.com.

5 views0 comments

Kommentare


bottom of page