Medicaid Exclusion Violation Results in Criminal Convictions

A husband and wife who operated a medical transportation company have both been convicted of Medicaid fraud because the husband was excluded from participating in federal healthcare programs due to a prior conviction for Medicaid fraud.

Tracy Roberts is listed as the owner of Community Transportation LLC, a specialized medical vehicle (SMV) company, and is a certified Medicaid provider of medical transportation services.  As part of the certification process, she agreed to comply with all state and federal regulations governing the Medicaid program.

Her husband, Joseph Roberts, was convicted of felony Medicaid fraud in 2007 and was sentenced to four years of probation.  As a result of his conviction, Mr. Roberts was placed on the federal exclusion list, which prohibited him from working for any certified Medicaid provider.

Exclusion means that Medicare, Medicaid, and other federal government health care programs will not pay the provider for services performed or ordered by the excluded party.  The law precludes not only direct payments to an excluded individual, but also indirect payments such as the payment of wages to an excluded individual who works with Medicare or Medicaid patients.

According to the government, Mr. Roberts provided transportation services on multiple occasions for Community Transportation, LLC, and Mrs. Roberts filed claims with Medicaid for reimbursement for those services.  Because services provided by an excluded individual are not eligible for reimbursement, these were considered false or fraudulent claims.

If you own or operate a healthcare business that submits claims to Medicare, Medicaid, or other government programs, you should check to ensure that your employees are not excluded from participating in those programs.  If you have inadvertently hired someone who is excluded, then you should consult an experienced Medicaid fraud attorney immediately to protect yourself.

To arrange a free and confidential consultation, call John Howley, Esq. at (917) 652-6504 or click here to contact our office via email.

John Howley, Esq.

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