Missouri AG: Charges 17 for $450K Medicaid Fraud Schemes

• Missouri Attorney General Catherine Hanaway has announced felony charges against 17 individuals for Medicaid fraud.
• The alleged schemes involved identity theft, personal care attendant fraud, and adult daycare billing abuses.
• These fraudulent activities collectively represent over $450,000 in stolen taxpayer funds.
• The Attorney General's office is seeking $454,328.71 in restitution from the defendants.
• The charges demonstrate a statewide effort to combat Medicaid fraud and protect vulnerable Missourians.

Anyone who attempts to exploit Missouri’s Medicaid program should understand that authorities will investigate, pursue charges, and seek full restitution for the public.

Missouri Attorney General Catherine Hanaway has announced felony charges against 17 individuals across the state, alleging their involvement in Medicaid fraud schemes that collectively diverted over $450,000 in taxpayer funds. These charges, resulting from extensive investigations by the state's Medicaid Fraud Control Unit, target various forms of deception, including identity theft, fraudulent billing for personal care attendant (PCA) services, and abuses within adult daycare operations. The Attorney General emphasized the state's firm stance against such illicit activities, stating that anyone attempting to exploit Missouri’s Medicaid program will face investigation, charges, and demands for full restitution.

The enforcement actions underscore a concerted effort to protect public assistance programs intended for vulnerable Missourians. The alleged schemes involved individuals and entities systematically defrauding the system, often by billing for services never rendered or by misrepresenting patient attendance and care. This aggressive enforcement highlights the ongoing commitment of the Missouri Attorney General's office to safeguard essential healthcare resources and ensure accountability for those who misuse them.

Among the cases brought forward, one scheme involved Tania Bonilla, Jose Jones, Basilio Delgado Munoz, and Henry Price, who are accused of orchestrating nearly three years of fraudulent billing through Jones’s company, Harmony at Home. This operation allegedly resulted in $70,864.15 in false claims, with Bonilla billing for services even when airline records placed her out of state or internationally, and on days she was hospitalized, including during childbirth. Another egregious case of Missouri healthcare fraud arrests involved Cartessie Johnson and Ulysses Calloway, who allegedly stole the identity of Kathleen White. They purportedly enrolled White as a caregiver and then billed for hundreds of shifts she never worked, totaling $44,783.17 for Johnson's claims and $26,495.43 for Calloway's, with funds reportedly used for personal expenses, including at a pawn shop. Both defendants also face identity theft charges.

Further demonstrating the breadth of the alleged Missouri Medicaid fraud enforcement, Kimberly Brown, owner of Divine Purpose Adult Daycare and later Care Professionals, is accused of billing for $53,057.36 in services not provided. Her companies allegedly submitted claims for adult daycare services after a client stopped attending due to an injury, including 98 fraudulent dates totaling $8,711.68 for that single client. Brown also purportedly billed for clients who were hospitalized, at medical appointments, or receiving services elsewhere, and submitted claims exceeding actual attendance logs. In another instance of personal care attendant fraud Missouri, Maci Legrand, who was barred from working as a caregiver due to a denied Good Cause Waiver stemming from her criminal history, allegedly enlisted Christal Calhoun to pose as the official attendant. Together, they are accused of splitting $27,743.76 in Medicaid payments for care that was not delivered, leading to a Medicaid recipient appearing disheveled and soiled at a hospital and later being diagnosed with cellulitis.

The Attorney General's office is actively seeking $454,328.71 in restitution from the 17 defendants, aiming to recover the full amount of taxpayer funds allegedly stolen through these fraudulent activities. This aggressive pursuit of restitution underscores the financial impact of such schemes on public resources and the state's determination to reclaim funds for their intended purpose.

Jess Bax, Director of the Missouri Department of Social Services, commended the collaborative efforts between his department's Medicaid Audit & Compliance Unit and the Attorney General's office. He emphasized the critical importance of protecting vital public resources and ensuring that Medicaid funds are utilized appropriately for the individuals who depend on them. The collective actions highlight a robust commitment to combating Medicaid fraud enforcement across Missouri, sending a clear message that fraudulent practices will be met with rigorous investigation and prosecution.

Compliance officers and legal counsel for healthcare providers in Missouri should review their internal controls and billing practices, particularly concerning personal care attendant services and adult daycare, to ensure robust fraud prevention measures are in place. The Attorney General's aggressive enforcement signals heightened risk for entities involved in Medicaid programs and necessitates proactive compliance audits to avoid similar charges.

Source: Based on official statements from the Missouri Attorney General.