Woman pleads guilty to $1.2M Medicaid fraud

Buckhead firm put in claims for services not rendered.

The owner and operator of a Buckhead-based health care company pleaded guilty to a $1.2 million Medicaid fraud scheme, authorities said Tuesday.

Diandra Bankhead, 42, used her company, Elite Homecare, to submit thousands of fraudulent claims for Medicaid services that were never provided to medically fragile children, the U.S. Attorney’s Office for the Northern District of Georgia said in a news release.

Between September 2015 and April 2018, Elite Homecare submitted more than 5,400 claims as a Georgia Pediatric Program (GAPP) provider, the release said.

Most of the claims were found to be fraudulent by investigators.

GAPP is an in-home nursing program that serves Medicaid-eligible children under the age of 21. Through the program, participating children are supposed to receive in-home skilled nursing services on an individual basis.

The medically fragile children who qualify under GAPP typically have autism, blindness, cerebral palsy, Down syndrome, epileptic seizures, paralysis or other disabilities requiring around-the-clock supervision.

In addition to pocketing the Medicaid claims, Bankhead became a certified GAPP provider by submitting fraudulent information to the Georgia Department of Community Health, the release said. That included her falsely saying a registered nurse was Elite Homecare’s RN supervisor without the nurse’s knowledge or authorization.

Bankhead also submitted several fraudulent claims that said her company’s employees provided services to multiple children simultaneously, which is impossible since GAPP requires one-on-one services, the release said.

Some of the claims also billed for more than 24 hours of services in a single day.

Many of the employees did not know their identities and credentials were being used in the claims, the release said.

She pleaded guilty to a count of health care fraud. Her sentencing is scheduled for January.

The case was investigated by the Department of Health and Human Services, Georgia Medicaid Fraud Control Unit and the FBI.