ATLANTA (September 4, 2019)—Diandra Bankhead, the owner and operator of Elite Homecare (Elite), an Atlanta-based home health care provider, has pleaded guilty to defrauding Medicaid by submitting thousands of fraudulent claims for services that were never provided to medically fragile children under the Georgia Pediatric Program (GAPP).
“Bankhead exploited Medicaid-eligible children who suffer from significant physical and cognitive disabilities,” said U.S. Attorney Byung J. “BJay” Pak. “Her fraud included billing for services never performed and for children never seen. Georgians dependent on these types of services deserve our best, not to be used by someone who is looking to enrich themselves at their expense.”
“The greed of this defendant deprived health care to many at risk children in Atlanta, focusing on profit rather than the care of our kids,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “The FBI will not stand by and allow those who commit fraud to take advantage of programs that are intended to support our state's most vulnerable citizens.”
“This plea is another example of our strong commitment to aggressively pursue health care providers who recklessly bill the Medicaid program,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “The OIG, our State law enforcement partners and the U.S. Attorney’s Office will continue to protect government health programs and those they serve.”
“This is one of many cases we have seen lately that involves someone undermining the integrity of the Medicaid program and neglecting their responsibility to support children who may desperately need these services. This trend is unacceptable, and we will continue to work with our federal partners to stop it in its tracks and protect this vulnerable population,” said Georgia Attorney General Chris Carr.
According to Pak, the charges and other information presented in court: GAPP is an in-home nursing program designed to serve Medicaid-eligible children under 21 years of age based on medical necessity. The program offers in-home skilled nursing services for medically fragile children who require nursing services, and personal care services, including feeding, bathing, dressing, personal hygiene, preparation of meal, and assisting with the mobility and ambulation of members.
Medically fragile children who are eligible for services under GAPP typically suffer from significant physical and cognitive disabilities, including autism, blindness, cerebral palsy, Down syndrome, epileptic seizures, and/or paralysis.
Bankhead's scheme began in approximately September 2015 and continued until April 2018. Over that time, Elite submitted more than 5,400 claims to Georgia Medicaid—the vast majority of which were fraudulent—and for which Elite received $1.2 million. Bankhead defrauded Medicaid in a number of ways, including:
- Submitting fraudulent credentialing information to the State of Georgia Department of Community Health in order to become a certified GAPP provider, including falsely representing that a registered nurse—without her knowledge or authorization—served as Elite’s RN Supervisor.
- Falsely representing to Medicaid that a registered nurse (RN) or RN Supervisor had conducted the initial evaluation of putative GAPP members as required by applicable regulations.
- Submitting fraudulent claims for in-home nursing services allegedly provided to families who had not retained Elite to provide any services.
- Submitting fraudulent claims in which Elite employees allegedly provided more than 24 hours of services in a given day.
- Submitting fraudulent claims where Elite employees were impossibly providing services to multiple children simultaneously.
- Submitting fraudulent claims in the names of multiple individuals, including RNs, who did not provide the services in question, and did know that their identities and credentials were being used.
- Submitting fraudulent claims that had been “upcoded”—that is claims which fraudulently increased the amount Medicaid paid Elite—by materially misrepresenting the level of care provided and the level of licensing for the individual allegedly providing the services. For example, Elite submitted fraudulent claims to Medicaid purporting that an RN (billed at $40/hour) had rendered the services when in fact a licensed professional nurse (billed at $30/hour) and/or personal care service provider (billed at $20/hour) had actually done so.
- Preparing fraudulent supporting documentation for the in-home nursing services that were never provided, including fraudulent patient care charts.
Bankhead pleaded guilty to one count of health care fraud. Sentencing for Diandra Bankhead, 42, of Atlanta, Georgia, is scheduled for Jan. 28, 2020 at 10:00 a.m., before Chief U.S. District Judge Thomas W. Thrash.
This case is being investigated by the Department of Health and Human Services, Georgia Medicaid Fraud Control Unit, and Federal Bureau of Investigation.
Assistant U.S. Attorney Alex R. Sistla is prosecuting the case.
