Home Health Care Owner sentenced for Defrauding Georgia Medicaid 

Diandra Bankhead, the owner and operator of Elite Homecare (“Elite”), an Atlanta-based home healthcare provider, has been sentenced for defrauding Medicaid out of nearly $1 million. Between September 2015 and April 2018, Bankhead submitted thousands of fraudulent claims for services that were never provided to medically fragile children under the Georgia Pediatric Program (“GAPP”).  “It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung J. “BJay” Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”  According to U.S. Attorney Pak, the charges and other information presented in court: GAPP is an in-home nursing program designed to serve Medicaid-eligible children under the age of 21 years of age based on a medical necessity. The program offers in-home skilled nursing services for medically fragile children who require nursing services, and personal care services, including feeding, bathing, dressing, personal hygiene, preparation of meal, and assisting with the mobility and ambulation of members.  Medically fragile children who are eligible for services under GAPP typically suffer from significant physical and cognitive disabilities, including autism, blindness, cerebral palsy, Down syndrome, epileptic seizures, and/or paralysis.  Bankhead’s scheme began in September 2015 and continued until April 2018. Over that time, Elite Homecare submitted more than 5,400 claims to Georgia Medicaid—the vast majority of which were fraudulent—and for which Elite received $1.2 million in reimbursement. Bankhead defrauded Medicaid in a number of ways.  Among the fraudulent claims that Bankhead submitted to Georgia Medicaid for services that were never performed were for services allegedly provided to an infant girl after she had passed away and three children, all under the age of thirteen, who suffered from cerebral palsy or Down’s Syndrome. These children were entirely dependent on others to complete the most basic tasks of life—feeding themselves, clothing themselves, bathing, and even standing up to walk.  In addition to the underlying fraud, Bankhead also failed to truthfully and completely disclose her finances to the United States Probation Office as required by her plea agreement. Rather, the information presented at sentencing established that Bankhead entered into a kickback arrangement with another Atlanta-based home health provider under which she “sold” twenty of Elite’s former clients in exchange for receiving a percentage of the Medicaid billings tied to those clients going forward. Such arrangements are generally unlawful under the federal Anti-Kickback Statute.  Bankhead, 43, of Atlanta, Georgia was sentenced by U.S. District Court Judge Thomas W. Thrash, Jr. to five years and three months in federal prison, and three years of supervised release, and ordered to pay $999,999, in restitution.  On August 28, 2019, Bankhead pleaded guilty to a criminal information pursuant to a written plea agreement charging her with one count of healthcare fraud.  This case was investigated by the Department of Health and Human Services, Georgia Medicaid Fraud Control Unit, and Federal Bureau of Investigation.  Assistant U.S. Attorney Alex R. Sistla prosecuted the case.