Donna Kay Sweeting worked Florida’s Medicaid system for several years, using unqualified case supervisors utilized by her company to bill the state millions in deceitful claims for customers who either didn’t need the services or get them, according to records submitted in Leon County court.
In many cases, her company, DS Connections, billed the state more than 1,000 hours for a single customer over a two-year duration. In at least 3 cases, the company billed the state for customers who were dead.
Detectives called it a fancy plan to defraud the state of countless taxpayer dollars indicated to assist kids and grownups with relentless psychological health problems. They stated the seriousness of the criminal activity was so terrific she might deal with 260 years in jail.
Sweeting, 55, appeared before Leon County Judge Nina Ashenafi Richardson Wednesday and pleaded innocent to 18 counts of Medicaid company scams, racketeering and worsened clerical criminal activities.
Sweeting turned herself into authorities willingly, stated her lawyer, Gary A. Johnson.
She was launched after publishing a bond of $152,500, surrendering her passport and concurring not to call her previous case supervisors or her company’s areas. The judge permitted her to return the home of Havre De Grace, Maryland.
Sweeting should go back to Leon County for a jury trial, which she required. A date has not yet been set.
After carrying out a two-year examination, the Medicaid Fraud Control Unit of the Florida Attorney General’s Office on Aug. 22 submitted charges connected to events in between July 2, 2011, and August 7, 2014.
Private investigators charged her with 2 counts of Medicaid scams over $50,000, 7 counts of scams in between $10,000 and $50,000, and 7 counts under $10,000.
According to a possible cause affidavit submitted by detectives, Sweeting was president of DS Connections based in Winter Park with her partner noted as vice president and signed up representative. The company also had placed in Tallahassee and Clermont.
As president, Sweeting employed case supervisors and managers who didn’t meet the minimum certifications or have the experience needed by Medicaid to submit ask for repayments.
Because many of them cannot meet the minimum certifications for the tasks they held, the company ought to not have been compensated for many million dollars in billings submitted to the state Medicaid workplace, the affidavit stated.
Each case supervisor was paid based upon the systems they billed. A system is 15 minutes of definable services based upon Medicaid guidelines. Supervisors would produce development notes recording the services they declared to be supplying. They ‘d forward their notes to the Tallahassee workplace, where a manager would evaluate the notes and confirm the services and total up to be paid.
The Tallahassee workplace would then send out the notes to the Winter Park workplace for last evaluation before sending the costs to the Florida Medicaid Program in Tallahassee. Florida Medicaid Program repays service providers $12 per system or $48 per hour.
The state Medicaid scams system used information mining efforts to track billings for targeted case management services from March 1, 2012, to February 28, 2014. DS Connections was recognized as one of the greatest paid companies, with more than 1,000 total quarter-hours in billings for customers with 3 or more sees in a single week, the affidavit stated.
On at least 2 celebrations, DS Connections was repaid $20,000 for numerous receivers at the very same address. DS Connections also was compensated for 7 customers for more than 1,000 hours of service over a two-year duration and was repaid $20,000 for among those 7 customers.
On 3 events, DS Connections was repaid for customers who were dead.
And one customer was 13 months old at the time DS Connections was repaid for services. That age is considered too young to get psychological health services, detectives stated.
The state attorney general of the United States opened an initial examination in March 2014. Private investigators talked to 18 receivers or the parents or guardians of receivers. 9 receivers were under 5 years of ages.
All specified the services were overstated or didn’t happen, the private investigator stated.
None of the customers appeared to struggle with the kind of consistent mental disorder that would need targeted case management service, the affidavit stated. Most didn’t have a history of mental disorder prior to patronizing of DS Connections, detectives observed. Most informed the detective they didn’t have psychological health problems.
Browse warrants were released for the Tallahassee and Winter Park workplaces, where records of both receivers and staff members were taken. Private investigators found that several the case supervisors didn’t have the degrees or experience dealing with kids and grownups with a mental disorder as needed by the targeted case management handbook.
Medicaid will just compensate for services offered by licensed case supervisors who meet academic and expert requirements. As an outcome, private investigators stated, DS Connections got $2.4 million in deceitful repayments.