ST. MARYS — The Georgia Attorney General’s Office has filed a lawsuit against Camden County-based Lighthorse Healthcare Inc. and its director Carlene Taylor for filing false Medicaid claims.
According to the complaint filed on behalf of three former employees, Carol Knowles, Deborah Middleton and Chrisi Gallagher, the company, under the leadership of Taylor, submitted false claims to Georgia Medicaid for services that were never provided from at least September 2013 through September 2015.
The state civil filing is in addition to a similar civil case filed earlier this year in U.S. District Court in Brunswick.
The complaint alleges Georgia Medicaid was billed as if a physician provided services, when, in fact, non-physician professionals provided the services.
The non-physican professionals providing services were either ineligible for Medicaid reimbursement or were eligible for payment at a lower rate, according to the complaint. As a result, the state claims it suffered damages and filed the complaint to recover those damages.
According to the complaint, more than 900 false claims were filed.
The civil penalty for knowingly making false claims or records is not less than $5,500 and not more than $11,000 for each fraudulent claim, plus three times the amount of damages sustained by the Georgia Medicaid program as a result.
Lighthorse was obligated to submit claims for services actually performed, identifying the services provided for reimbursement, documenting the patient’s medical records for services performed. The company billed for office visits and other forms of therapy as if its medical director provided the services, according to the complaint.
“Instead, nurse practitioners, licensed professional counselors, licensed associate professional counselors, licensed social workers, unlicensed counselors and social worker trainees provided the services,” the complaint said.
In addition to misrepresenting who provided the services, Lighthorse, through Taylor, routinely encouraged its staff to misrepresent which services were provided, by insisting that they record CPT codes on visit notes that reflected additional services not provided or that a higher level of service was provided, according to the complaint.
The physician was often not at the site when the services were taking place and his “mere supervision” alone would not be sufficient for billing the services under the physician’s provider number, the complaint claims.
Lighthorse and Taylor would not have been reimbursed for claims for therapy service if the company would have disclosed that nurse practitioners, licensed professional counselors, licensed associate professional counselors, licensed social workers, unlicensed counselors or social worker trainees provided the services.
And the claims for office visits would have been at a lower rate if Lighthorse had disclosed nurse practitioners provided the services, the complaint said.
Taylor is also accused in the lawsuit of regularly sending under-qualified employees to evaluate emergency department patients in crisis situations. She also sent clinical trainees to perform the assessments alone, according to the complaint.
Taylor is accused of instructing the trainees to either use her login credentials or the login credentials of the other licensed professionals to write the visit notes, according to the state’s complaint.
“Thus, the trainees falsified visit notes at Dr. Taylor’s direction,” the complaint said.
The complaint gave several specific examples where Lighthorse trainees responded to crisis calls and the company submitted claims as if they were performed by the company’s physician.
In all, Taylor is accused of filing false claims under the Georgia False Medicaid Claims Act, making a false record or statement and payment by mistake for the state’s erroneous belief that a specific level of service was provided to patients.