Colorado Medicaid Fraud Control Unit

Date:

Colorado Man Charged With Filing Hundreds Of Fraudulent Medicaid Claims

2011 HEAT Provider Compliance – Health Care Fraud Enforcement Panel – Fraud Control Unit

FOR IMMEDIATE RELEASE

– A Colorado man was arrested today and charged with defrauding Medicaid by billing the government health care program for services that were not rendered.

Thomas A. Thurber, age 81, formerly of Meriden, Connecticut, and currently residing at South Ridge Road in Bayfield, Colorado, was arrested today by Inspectors from the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney and charged with one count each of Larceny in the First Degree By Defrauding A Public Community and Health Insurance Fraud. According to the arrest warrant affidavit, Thurber was enrolled as a Behavioral Health Clinician Performing Provider under the Connecticut Medical Assistance Program, also known as CMAP. CMAP includes Medicaid and is part of the Connecticut Department of Social Services . The investigation found that between January 2017 and July 2020, Thurber submitted to Medicaid a total of 273 false claims in the amount of $43,993.93 for services that were never rendered.

The amount of money profited by Thurber in the amount of $43,993.93 constitutes the crime of Larceny in the First Degree by Defrauding a Public Community. The submission of claims to the Department of Social Services by Thurber containing false, incomplete, deceptive or misleading information constitutes the crime of Health Insurance Fraud.

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    Want To Report Fraud Or Abuse

    If you suspect that an at-risk adult or juvenile, or a person with a developmental or physical disability has been abused or neglected, or that a patients funds are being used improperly, call the police.

    If you believe the abuse or neglect involves a Medicaid funded facility or provider, call the Colorado Attorney Generals Medicaid Fraud Control Unit at 720-508-6696 or file a complaint online.

    Your Rights And Control Under Eu Gdpr

    Eliminating Medicaid fraud

    Data Controllers and Processors.

    Our Customers use our Services to post job opportunities, evaluate job applicants, manage their human resource activities, and train their workforce. In conducting these activities, the Customer maintains control over what personal data is collected, how it is used, how long it is retained, and who it is disclosed to. For purposes of the EU GDPR, the Customer is considered a data controller in these respects and we are a data processor. In other instances, such as when we use cookies or contact you about our Services, we will determine the means and purpose of processing.

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    Colorado Healthcare Fraud/medicare Fraud Enforcement

    In Colorado, major healthcare fraud is civilly and criminally prosecuted by the District of Colorado United States Attorneys Office.

    The federal government sometimes accomplishes this task with the assistance of the Colorado Medicaid Fraud Control Unit . Both entities are, in turn, often assisted in their efforts by the bravery and actions of whistleblowers.

    Modeled after the federal False Claims Act, the Colorado False Claims Act permits private citizens to bring qui tam actions on behalf of the State of Colorado to recover treble damages and civil penalties. Colo. Rev. Stat. §§ 25.5-4-303.5 et seq.

    Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Colorado qui tam statute as part of an action under the federal False Claims Act. We do so under the Courts pendent jurisdiction.

    The liability provisions of the Colorado Medicaid False Claims Act, Colo. Rev. Stat § 25.5-4-305, provide that it is unlawful to:

    Knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval

    Knowingly makes, uses or causes to be made or used, a false record or statement material to a false or fraudulent claim

    Conspires to commit a violation of paragraphs to of this subsection

    Cases completed in Colorado that were originally brought in a Colorado federal court include:

    Colorado Springs Woman Charged With Stealing $240k From Medicaid In Fraudulent Billing

    May 19, 2022 Attorney General Phil Weiser today announced that the Colorado Department of Law has filed charges against a Colorado Springs woman for submitting Medicaid claims and being paid for psychological testing services that never happened.

    An investigation by the departments Medicaid Fraud Control Unit found that between Aug. 25, 2017, and Feb. 26, 2021, Martha Sutherland, operator of Front Range Mental Health and Summit Assessments in Colorado Springs, routinely filed claims and received Medicaid reimbursement for pre-bariatric surgery mental health assessments that were not provided. According to the arrest warrant affidavit filed in El Paso County District Court, Sutherland also billed for the same service multiple times. The total value of theft is $240,000.

    Sutherland is charged with theft, a class three felony, and cybercrime, a class four felony.

    Medicaid provides essential health care services for many of our states most vulnerable residents, Weiser said. We will hold accountable those who would take advantage of this system for their own gain and, in turn, take resources away from those in need.

    The case is filed in El Paso County District Court and the case number is 2022CR2313.

    The filing of criminal charges is merely a formal accusation that an individual committed a crime under Colorado laws. All defendants are presumed innocent until proven guilty.

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    History Of Medicaid Fraud Control Units

    Medicaid, which was created in 1965, operated with few controls against fraud and without any specific state or federal law enforcement agencies responsible for monitoring criminal activity within the program. The need for the MFCUs came about when the public and Congress realized that too many nursing home patients were held hostage by the greed of a small number of facility operators and often dishonest health care practitioners who used the Medicaid program as their own private ATM machine.

    In 1977, legislation was passed which provided each state with the opportunity and resources to establish a MFCU to investigate and prosecute provider fraud and resident abuse. Permanent federal funding was provided for the MFCUs in 1980, allowing the federal government to ensure each Unit’s activities are devoted exclusively to investigating and prosecuting provider fraud, resident abuse, and fraud in the administration of the Medicaid program.

    For more information about a state’s Medicaid Fraud Control Unit, visit their website below.

    Introduction Scope Of This Policy

    Nine arrested in Medicaid fraud scheme

    The purpose of this Privacy Policy is to describe how we collect, use, store, protect, and disclose personal data online and offline. This Policy applies to personal data we collect or use, and applications owned or controlled by Govermentjobs.com, Inc. , including our related brands NEOGOV.com, NEOED.com, Governmentjobs.com, Schooljobs.com, and our mobile app , or affiliated companies .

    By using any part of the Services you agree that you have read this policy, your personal data will be processed as described herein, and you agree to be bound by this Policy. This Policy is incorporated into our Terms of Use. Definitions not explicitly defined herein shall retain the meaning as prescribed in the Terms of Use. Any dispute related to privacy is subject to the Terms of Use and this Policy, including limitations on liability.

    We are the controller for the personal data discussed in this Policy, except as noted in the Where We Are a Service Provider section below.

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    Medicaid Fraud Control Press Releases

    Date Description

    8/27/21Campbell County Health Agrees to Pay $1.5 Million in Wyoming Medicaid Repayment

    5/6/21Jury Convicts South Dakota Woman of Health Care Fraud and Identity Theft

    1/22/21Platte County Woman Sentenced in Medical Fraud Case

    10/2/2018Cheyenne, Wyoming Resident Sentenced for Defrauding Wyoming Medicaid

    1/8/2018Powell, Wyoming Psychologist Sentenced to Three Years in Prison for Health Care Fraud

    10/5/2017State of Wyoming Joins EpiPen Settlement

    6/23/2017Colorado Podiatrist Sentenced to Prison for Health Care Fraud

    2/3/2014Wyoming Medicaid Provider Indicted for Health Care Fraud

    4/4/2013Three Wyoming Medicaid Providers indicted for Health Care Fraud

    3/5/2013Natrona County Woman Pleads Guilty to Medicaid Fraud

    2/19/2013Cheyenne Provider Found Guilty of Medicaid Fraud

    Data Security And Integrity

    We implement physical, technical, and administrative safeguards designed to maintain data accuracy, integrity, and security, prevent unauthorized access, and facilitate correct use of personal data. Our security measures take into account the risk of harm to you and Customers, as well as the availability of technology, industry common practices, effectiveness of mitigation controls, and the sustainability of those controls by us.

    Although we maintain the controls listed herein, transmission of data is not without risk and we complete security of your personal data cannot be guaranteed. Please note, you are responsible for keeping your login credentials secret at all times, including your username and password.

    In the event we believe the security of your personal data in our possession or control may be compromised, we may seek to notify you by e-mail and you consent to our use of e-mail as a means of such notification.

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    Colorado Medicaid False Claims Act

    Where can I find the full text of the Colorado Medicaid False Claims Act?

    The Colorado Medicaid False Claims Act is written into the Colorado statutes at Colo. Rev. Stat. §§ 25.4-4-303.5, et seq.

    What kind of fraud is covered by the Colorado Medicaid False Claims Act?

    The CMFCA only applies to false claims made related to Health First Colorado, Colorados Medicaid program.

    Personal Data We Collect About You And Why

    Medicaid Theft: Springs Speech Dr. Fraudulently Billed $1.2M: AG ...

    In this Section we set out general categories of personal data we may collect and the purpose for using your personal data, including the personal data collected and processed over the past year. We collect and process personal data to provide you the Services, fulfill our contractual responsibility to deliver the Services to our Customers, fulfill your requests, and pursue our legitimate interests and our business and commercial purposes. We also automatically collect data during your usage and collect other personal data about you from other sources. Your personal data will only be collected and used for purposes stated herein, where you provide additional consent, or as required by law or regulation – including national security or law enforcement requirements.

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    We collect personal data from you directly when you visit our Services from either your computer, mobile phone, or other device, attend one our events, or communicate with our personnel. The categories of personal data we collect from you, including over the past year, involve the following:

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    Information Collected When Using the PowerLine Application

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    Colorado Substance Abuse Treatment Clinic And Owner Agree To Settle False Claims Act Allegations

    Springbok Health Inc., a medical clinic with locations in Colorado Springs and Pueblo West, Colorado, and Mark Jankelow, Springboks owner and Chief Executive Officer, have agreed to pay at least $125,000, and up to as much as $335,494, to resolve allegations they violated the False Claims Act by billing Medicare and Medicaid for high-complexity and prolonged medical evaluation and management services when such services were not rendered.

    Between 2017 and 2019, Springbok and Jankelow allegedly billed Medicare and Medicaid for expensive medical evaluation and management services when, at most, less expensive counseling services were provided. The resolution is based on Springboks and Jankelows ability to pay.

    Billing Medicare and Medicaid for more expensive services than were actually rendered depletes the limited resources of these vital health care programs, said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Department of Justices Civil Division. We will continue to safeguard taxpayer dollars and hold accountable those who knowingly misuse such funds.

    Providers who submit false claims to Medicare and Medicaid for their financial gain undermine the economy and integrity of federal health care programs, said Special Agent in Charge Curt L. Muller of the Department of Health and Human Services, Office of the Inspector General . We will continue to work with our law enforcement partners to prevent the waste of valuable taxpayer dollars.

    Overview Of Your Data Rights

    Your data rights for personal data where we are the data controller.

    You can review and enforce your personal data rights through your account, communications you receive from us, third party mechanisms, or with the assistance of our support team using the emails at the end of this Policy. For instance, you can:

    Your data rights for personal data you submit to our Customers.

    Upon making your personal data available to an employer , your personal data may be controlled by our Customer. In this regard, we are a data processor for personal data Customers maintain have us process, and your data rights are subject to our Customers internal policies. For these reasons, we are not in a position to directly handle data requests for personal data controlled by Customers. You should contact the Customer regarding personal data they may hold about you and to exercise any data rights you may have. We will cooperate with such inquiry in line with applicable law and our contractual obligations with the Customer.

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    About Medicaid Fraud Control Units

    Medicaid Fraud Control Units conduct a statewide program for the investigation and prosecution of health care providers who defraud the Medicaid program. Other duties of a MFCU include:

    • Reviewing complaints of abuse or neglect in nursing home and board and care facilities.
    • Reviewing complaints of the misappropriation of patients private funds in nursing homes.
    • Investigating fraud in the administration of the program.

    Where We Are A Service Provider

    North Dakota’s New Medicaid Fraud Control Unit

    Our Customers are organizations such as federal, state, local, tribal, or other municipal government agencies , private businesses, and educational institutions , who use our Services to evaluate job applicants and manage their relationship with their personnel. When we provide our Services to our Customers, the Customer generally controls and manages the personal data, and we process personal data as a data processor or service provider. Our legal obligations as a processor and service provider are set out in our Customer contracts and policies.

    For instance, if you apply to a job or your employer utilizes our Services to manage their relationship with you, the personal data collected about you is generally controlled by the employer . This Policy does not describe the processing of your personal data by our Customers, and we encourage you to visit the Customers privacy policy for information about their privacy practices. For example, if you applied to a job at a local state agency, you should contact that agency with any questions you may have relating to the personal data processing by that state agency within our Services.

    Where we serve as a data processor, our Customer contracts and policies require us to either instruct you to contact our Customer, or redirect your inquiry to our Customer.

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    Medicaid Fraud Control Unit

    The Colorado Medicaid Fraud Control Units mission is to protect state and federal funds from fraud against Medicaid by individuals or companies who provide services and to protect residents of long-term care facilities from physical abuse or neglect.

    The MFCU employs a professional staff of criminal investigators, an auditor, a nurse investigator, and prosecutors experienced in criminal and civil investigations.

    The MFCUs abuse jurisdiction to prosecute physical abuse or neglect extends to all personal care boarding homes, adult day care facilities, hospitals, skilled nursing centers, rehabilitation centers, long-term facilities, and some assisted living centers regardless of whether the resident is a Medicaid recipient or not. The Unit does not investigate abuse in the home or in non-Medicaid facilities. Our fraud jurisdiction covers all Medicaid providers.

    The MFCU has authority to hold individuals or entities accountable through criminal prosecution and/or civil litigation. The Unit also makes recommendations to the U.S. Department of Health and Human Services, Office of the Inspector General to exclude individuals or entities from participating in Federally-funded programs.

    If you are a victim of fraud, abuse, or neglect by a Medicaid provider, or if you know of or suspect an at-risk person is a victim of these crimes, you should contact your local law enforcement agency or the Medicaid Fraud Control Unit.

    The MFCU is a member of:

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