South Carolina Attorney General Alan Wilson announced that his office’s Vulnerable Adults and Medicaid Provider Fraud unit (VAMPF) had arrested a 59-year-old woman on one count of Medical Assistance Provider Fraud. She was booked into the Alvin S. Glenn Detention Center on June 10, 2025.
An investigation by VAMPF revealed that, between December 4, 2023, and June 21, 2024, the defendant allegedly knowingly and willfully submitted false claims for payment to the South Carolina Department of Health and Human Services, which administers the state’s Medicaid program. Specifically, it is alleged that the defendant, as a care attendant with a home healthcare company, submitted false timesheets indicating she provided services to a Medicaid beneficiary when she had not.
This case was referred to law enforcement by the home healthcare company, which cooperated fully with investigators. It will be prosecuted by the Attorney General’s Office.
Medical Assistance Provider Fraud is a Class A misdemeanor, punishable by up to three years in prison and a fine of up to $1,000.
Under federal regulations, VAMPF has authority over Medicaid provider fraud; abuse and neglect of Medicaid beneficiaries in any setting; and abuse, neglect, and exploitation of individuals residing in assisted living facilities or nursing homes.
Compliance Perspective
Issue
Honesty, accuracy, and integrity are imperative for the provision of safe and effective healthcare. Falsification of documents regarding care, incomplete or inaccurate documentation of care, failure to provide the care documented, or other acts of deception or omission raise serious concerns about an individual’s ability to provide safe healthcare. Falsified documentation and misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care.
Discussion Points
- Review your policies and procedures for following standards of care and requirements for accurate documentation. Also review your policies and procedures for operating an effective compliance and ethics program. Update as needed.
- Train appropriate staff on your policies and procedures for following standards of care, accurate documentation, and meeting regulatory requirements. Also train all staff on your compliance and ethics policies and procedures upon hire and at least annually, including their responsibility to identify and report any concerns of fraud, waste, or abuse of government funds in a timely manner.
- Periodically audit medical records and timesheets to ensure that documentation is complete, meets standards for content and timeliness, and that entries have not been falsified or erroneously reported in any way.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*