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Attorney General Rutledge Announces Faulkner County Women Sentenced for Medicaid Fraud

November 23, 2020

See Full Press Release at the link below:

https://www.arkansasag.gov/media-center/news-releases/rutledge-announces-faulkner-county-women-sentenced-for-medicaid-fraud/

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COVID-19 Resources for Medicaid Providers

March 20, 2020

The following are emergency memoranda related to billing for laboratory services and telemedicine during the COVID-19 public health emergency.

https://static.ark.org/eeuploads/omig/Memorandum_DMS-01_(physician_telemedicine).pdf

https://static.ark.org/eeuploads/omig/MEMORANDUM_DMS-02_(OBH_telehealth).pdf

https://static.ark.org/eeuploads/omig/Memorandum_DMS-03_(Lab_tests).pdf

 

Please visit the following DHS webpage for more updates related to Medicaid Providers:

https://humanservices.arkansas.gov/resources/response-covid-19

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Governor Hutchinson’s Executive Order 20-06

March 20, 2020

On March 17, 2020 Governor Hutchinson signed Executive Order 20-06 to amend Executive Order 20-03.  This proclamation is in regard to the public emergency Governor Hutchinson declared in response to the COVID-19 pandemic.  This order is to assist state agencies to render maximum assistance to Arkansas.  You can read the entire order here:

https://static.ark.org/eeuploads/omig/EO_20-06_.pdf

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Governor Hutchinson’s Executive Order 20-03

March 20, 2020

Governor Hutchinson signs Executive Order 20-03 Declaring an Emergency and ordering the Department of Health to take action to prevent the spread of COVID-19

https://static.ark.org/eeuploads/omig/EO_20-03._.pdf

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Stay Informed with Up-to-Date Information about COVID-19

March 20, 2020

Please visit the following links to stay informed with up-to-date coverage on the COVID-19 in Arkansas

https://www.healthy.arkansas.gov/programs-services/topics/novel-coronavirus

https://www.adem.arkansas.gov/external-affairs-educationoutreach

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Arkansas Drug Take Back Day 2019 Set for October 26, 2019

October 21, 2019


Arkansas Prescription Drug Takeback Event 2019

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Act 519 Allows Criminal Justice Data Sharing Enhancement

April 05, 2019

Thanks to Sen. Missy Irvin and all those who made SB266, now Act 519 possible. This bill was a collaboration between DIS and ACIC so criminal justice history information could be shared with non-criminal justice agencies. This law will allow agencies to make better data driven decisions through controlled data sharing for special projects such as support for crisis stabilization units, reducing duplication of healthcare costs across agencies, and much more. #collaboration #datasharing

Link to Act 519 can be accessed here

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State’s Medicaid Spending Falls Off

August 08, 2018

Arkansas' Medicaid spending fell by $22 million in the fiscal year that ended June 30, the first annual drop in spending for the program state officials could remember. 

The overall decrease came despite slightly higher spending on Arkansas Works, as the expanded part of the state's Medicaid program is known. 

Arkansas Works spending rose by less than 1 percent to $1.91 billion. That was more than offset by a $31 million decrease in spending on the traditional Medicaid program, which covers primarily children from low-income families and poor people who are elderly or disabled. 

The article mentioned above was written by Andy Davis at the Arkansas Democrat Gazette and can be found in its entirety here

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Judge Upholds Arkansas’ Suspension of Medicaid Payments to Provider; Halt Ordered After Former Exec’s Arrest

July 24, 2018

Arkansas officials acted properly in suspending Medicaid payments to a Missouri-based behavioral health provider, an administrative law judge ruled Monday.

Arkansas Medicaid Inspector General Elizabeth Smith suspended the payments to Preferred Family Healthcare on June 29 after a former executive with the nonprofit was arrested in the improper billing of almost $2.3 million in claims for mental health services.

Springfield-based Preferred Family appealed the suspension, leading to Monday's ruling by Administrative Law Judge Vicki Pickering.

Pickering cited a federal regulation requiring states to suspend Medicaid payments in response to a "credible allegation of fraud."

"OMIG does not have to prove the validity of the fraud, but simply must establish ... that there are credible allegations of fraud that have been verified and have an 'indicia of reliability,'" Pickering wrote, using an abbreviation for the inspector general's office. "OMIG has met its burden in this case."

Smith said she was pleased with the decision and believes the suspension was "the right thing to do under the circumstances."

Asked whether Preferred Family will appeal the decision to circuit court, spokesman Reginald McElhannon said in an email that the organization is "reviewing the decision and its impact."

The nonprofit is the biggest provider of counseling for troubled youths and adults in the state.

A federal investigation involving Preferred Family has led to the conviction of four former state lawmakers: Micah Neal and Jon Woods of Springdale, Eddie Cooper of Melbourne and Henry "Hank" Wilkins IV of Pine Bluff.

Preferred Family has 47 locations in Arkansas and others in Missouri, Kansas, Illinois and Oklahoma.

Rusty Cranford, a lobbyist who was a director of Preferred Family's Arkansas operations, pleaded guilty last month to a multimillion-dollar bribery scheme in Arkansas.

Jerry Walsh, executive director of the now-shuttered South Arkansas Youth Services agency in Magnolia, pleaded guilty last week in federal court to funneling more than $380,000 of the agency's money to Cranford with the goal of preserving the agency's state contracts.

The Medicaid payment suspension came after Robin Raveendran, a former executive vice president, was arrested June 28 on two felony counts of Medicaid fraud related to claims submitted from Jan. 1, 2015, to Oct. 19, 2017.

According to an investigator's affidavit, Raveendran, a former administrator with the state Medicaid program, directed Preferred Family employees to bill Medicaid for the full cost of services provided to patients who were enrolled in both Medicare and Medicaid, instead of just the part of the bill that Medicare didn't cover.

The scheme resulted in more money for Preferred Family Healthcare because Medicaid's rates for the same services were higher than Medicare's, Rhonda Swindle, an investigator with the state attorney general's office, wrote in the affidavit.

The claims submitted to the Medicaid program were "manipulated" to appear as though they had already been processed by Medicare and represented only the part that Medicare didn't pay, rather than the full bill, Swindle wrote.

Medicare is the federal health insurance program for the elderly and disabled. Medicaid is funded by the state and federal governments and covers low-income people.

In addition to suspending the Medicaid payments, the state Department of Human Services has said it will terminate Preferred Family's contracts for mental health and substance abuse services outside the Medicaid program. In a letter to employees in early July, the nonprofit said cancellation of those contracts would leave it unable to continue operations in Arkansas.

At a July 13 hearing over the suspension appeal, Medicaid Director Dawn Stehle said the program began working on a plan in April, after she learned of the attorney general's investigation, to help Preferred Family patients switch to other providers, according to Pickering's order.

Smith said the suspension will stay in place at least until Raveendran's criminal case is concluded. If he is convicted, the state could make the payment suspension permanent, she said.

The article mentioned above was written by Andy Davis at the Arkansas Democrat Gazette and can be found here

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OMIG Investigation Results in Medicaid Fraud Conviction

November 30, 2017

For more information, click here. 

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Arkansas Attorney General Leslie Rutledge Announces Arrest of Little Rock Woman for Medicaid Fraud

August 11, 2017

Shavita Wilson, 46, of Little Rock, surrendered herself in Pulaski County District Court on three outstanding warrants. Click here  for more information.  

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Arkansas Attorney General Leslie Rutledge Announces Arrest of Two Central Arkansas Women for Medicaid Fraud

July 13, 2017

Click here to read the press release in its entirety. 

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OMIG Investigation Leads to Conviction of Two School-Based Speech Therapists

June 15, 2017

Click here for more information. 

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OMIG Fraud Referral Leads to Criminal Conviction and $400,000 Civil Judgment

June 05, 2017

Click here for more information. 

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OMIG Mentioned in the Jonesboro Sun

February 15, 2017

JONESBORO — Following the arrest of two speech pathologists formerly contracted with the Bay School District, Superintendent Chip Layne said Monday the district had put the issue behind them.

Layne said Paula Riggs, 49, of Jonesboro, and Hannah Riggs, 24, of Paragould, previously were contracted with the district, but the contracts were terminated "over a year ago," he said. Layne also said when the issue arose in his district, school officials took immediate action to address the situation.

"It didn't happen recently, and we've used other services for almost a year now. (The arrests) are the result of an investigation and something we've known about for a little while," Layne said. "I have no other comment on this."

According to board minutes from Feb. 8, 2016, the Bay School Board voted 5-0 to terminate the contract with Paula Riggs LLC. Right after that vote, the board unanimously approved a speech contract with Kidabilities of Jonesboro.

Paula Riggs is a speech language pathologist (SLP) and Hannah Riggs is an SLP assistant.

According to court documents filed in Pulaski County Circuit Court, Paula Riggs is accused of two counts of Medicaid fraud and one count of non-maintenance of Medicaid records. All three counts are felonies, and Riggs pleaded not guilty on all counts at a hearing Wednesday.

More court documents indicate Hannah Riggs is accused of two counts of Medicaid fraud and one count of non-maintenance of Medicaid records. She pleaded not guilty to all three charges.

A press release from Arkansas Attorney General Leslie Rutledge said both women billed Medicaid for services not rendered. The release states Paula Riggs billed $26,242.56, while Hannah Riggs billed $5,854.96, though a later press release from the Medicaid Inspector General said Paula Riggs billed $36,992.00 for services not rendered and Hannah Riggs billed $5,158.96 for services not rendered.

Brett Hays, a spokesman with the Medicaid Inspector General, said the $26,242.56 was the total billed for one of Paula Riggs' two charges.

Hays said auditors used data analytics among services billed across the state to notice outstanding bills. He said auditors noticed the hours billed for services was significantly greater from the two women than state averages.

Hays said Bay district officials were cooperative in the effort, but they knew very little about the investigation.

According to an affidavit for arrest, Paula Riggs and Hannah Riggs committed the fraud from "about Oct. 10, 2013, to Sept. 19, 2015."

Hays said auditors had little contact with the school before they visited the district Oct. 5, 2015. School attorney Donn Mixon said officials asked to see "the woman and her assistant." The officials also talked with Layne and notified him of the suspected fraud.

Once auditors filed their report, they referred it to the Medicaid Fraud Control Unit of the Attorney General.

The affidavit states the fraud occurred, in part, when Hannah Riggs, an assistant SLP, charged services based on a higher rate than she should have. The affidavit states Riggs should have charged $17.40 per unit (15 minutes of service), but instead charged the rate of an SLP — $21.76.

"From Oct. 7, 2013, to Jan. 8, 2015, Ms. Riggs failed to apply the modifier code 236 times, overbilling the appropriate Medicaid rate for a sum of 856 units, totaling $3,732.16," the affidavit states.

Mixon said Layne removed Paula Riggs and Hannah Riggs from the school the day the auditors visited the district and notified the two women that a contract for services between them and the school would be terminated. Mixon said the two women were removed from school that day and haven't contracted services with the district since.

"Typically, they don't bill through the schools, but instead bill privately," Mixon said. "There are some schools that do their own billing, but it's extraordinarily rare."

Medicaid Inspector General Elizabeth Smith said in a press release the investigation revealed both women failed to properly code submitted claims, which resulted in a recovery of $160,911.78 in other services through the investigation.

By Dixon Land 
Sun News Staff

(The article can also be found on the Jonesboro Sun's webpage in the Archives Section at:  jonesborosun.com)

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OMIG Investigation Leads to Arrest of Two Medicaid Providers & $160,911.78 in Recovery

February 10, 2017

On February 8, 2017, Paula Riggs, of Jonesboro, and Hannah Riggs, of Paragould, were arrested after respective warrants were issued by the Medicaid Fraud Control Unit for the Office of Attorney General (MFCU). Both cases originated from an investigation performed by the Office of Medicad Inspector General (OMIG). Click here for more information.

Please click here to view the Arkansas Attorney General Office's information concerning this case. 

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OMIG Fraud Referral Leads to Arrest

October 17, 2016

A 49-year-old Conway woman was arrested during the week of October 10, 2016 on suspicion of fraudulently billing Medicaid more than $3,500. Click here to read more. 

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Beacon Health Options Announces Changes to Group Psychotherapy Codes to RSPMI Providers

October 11, 2016

To read more, click here

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Elizabeth Smith, Arkansas Medicaid Inspector General, Mentioned in the Southwest Times Record on her Proposal to Cap Medicaid Reimbursements for Group Therapy

October 05, 2016

To view this Southwest Times Record article, click here.  (Article dated September 24, 2016)

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Arkansas Democrat-Gazette Group Therapy Medicaid Code Editorial

October 04, 2016

Click here to read the editorial in its entirety. (Editorial dated October 4, 2016)

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Arkansas Panel Adopts Mental Health Medicaid Cap

October 04, 2016

Arkansas panel adopts mental health Medicaid cap, and for more information, click here to read the article in its entirety.  (Article dated September 21, 2016)

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ARRX Journal Features Article on Medicaid Inspector General

December 15, 2015

Medicaid Inspector General Elizabeth Smith was featured in the Fall 2015 issue of the ARRX Journal. The article provides a brief professional background on Elizabeth Smith and detailed information on how the Office of the Medicaid Inspector General makes its top priority to reduce Medicaid waste, fraud and abuse.

For the full text of the ARRX Journal article, click here.

For more information on the ARRX Journal, please go to the Arkansas Pharmacists Association’s webpage at: http://www.arpharmacists.org/.

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Healthcare Journal of Little Rock Features Article on Medicaid Inspector General

October 26, 2015

Medicaid Inspector General Elizabeth Smith was featured in the September/October 2015 issue of the Healthcare Journal of Little Rock. The article is a Q & A about her experience and what she brings to the table as the newly appointed Medicaid Inspector General. For the full text of the Healthcare Journal of Little Rock article click here. For more information on Healthcare Journal of Little Rock visit http://www.healthcarejournallr.com

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