A Jacksonville, Florida owner of an assisted living facility (Adams Adult Family Care Home) was arrested last week for allegedly committing medicaid fraud. According to Florida Attorney General Bill McCollum, the Jacksonville assisted living facility owner submitted false claims in excess of $20,000 to the Florida Medicaid program and was arrested by the Attorney General’s Medicaid Fraud Control Unit. The assisted living facility owner is suspected of running the facility without the proper license. More specifically, the facility was only licensed to care for four adult residents, but the facility owner is suspected of having more than four residents, including child residents, and charging the Florida Medicaid program for 19 months of reimbursements for the unauthorized residents.
According to the State Medicaid Fraud Control Units most recent annual report covering fiscal year 2006 issued by the Department of Health and Human Services Office of Inspector General, the various state Medicaid Fraud Control Units (MFCU) were created to investigate and prosecute Medicaid fraud and patient abuse and neglect. In 2006, the various MFCU’s recovered more than $1.1 billion and obtained 1,226 criminal convictions pursuant to their investigations and prosecutions.
Medicaid is a federal program, but Florida, like each other state, is authorized to administer the program and set certain standards in terms of eligibility and reimbursements. Generally, medical providers and assisted living facilities that are enrolled in the Medicaid program can provide care and treatment to individuals and make a claim for reimbursement to the Florida Medicaid program. Medicaid fraud is often characterized by a situation where a provider enrolled in the Florida Medicaid program will submit a false claim for reimbursement for: services that were not actually rendered to residents or patients, services that were not necessary or not authorized under the program, medical equipment not provided to the patient or resident or amounts greater than the appropriate value of the service.
The owner of the Adams Adult Family Care Home is charged with a third degree felony and is subject to a maximum prison sentence of five years, a $5,000 fine and restitution of the amount found to have been fraudulently taken from the Medicaid program.