Former business owner accused of Medicaid fraud

Former business owner accused of Medicaid fraud
Posted at 11:02 AM, Sep 07, 2017
and last updated 2017-09-07 09:08:50-04

TALLAHASSEE, Fla. (WTXL) - A woman whose company provided case management for Medicaid recipients is facing charges resulting from allegations that she fraudulently billed Florida for claims.

Donna Kay Sweeting, 55, who is living in Havre de Grace, Maryland, was arrested Wednesday and later bonded out of the Leon County Jail. She returned home to await a date to be set for her jury trial.

As president of DS Connections, Sweeting filed claims that were for items or services that are not authorized to be reimbursed by Medicaid, an investigator with the Medicaid Fraud Control Unit said in a sworn complaint.

She and her company were to have provided case management for people who demonstrated signs of severe and persistent mental illness. 

Sweeting is charged with two felony counts of Medicaid Provider Fraud of $50,000 or more, seven counts of fraud of more than $10,000 but less than $50,000, seven counts of fraud of $10,000 or less, one felony count of racketeering, and one felony count of Aggravated White Collar Crime.

She is accused of filing the claims between Aug. 15, 2012, and July 7, 2014. Her company had locations in Tallahassee, Winter Park and Clermont.

The Florida Medicaid program paid DS Connections $48 for each hour billed based on a unit cost of $12 for 15 minutes. DS Connections, the complaint said, was one of the highest paid providers.

The fraud investigator found that Medicaid reimbursed DS Connections twice for more than $20,000 for multiple recipients at the same address. DS Connections was reimbursed for more than 1,000 hours during a two-year period for seven recipients, and for one of the seven people the company was reimbursed more than $20,000. 

Three recipients that the company was reimbursed for were dead, the investigator said, and one recipient was 13 months old, "too young to benefit from mental health targeted case management."

In examining 18 recipients, or their guardians, the investigator said, he found nine recipients who were five years of age or younger.

Presented with the receipts, the recipients, or their guardians, the investigator said the services that DS Connections billed Medicaid for was either over-inflated or did not occur. 

The seizure of DS Connections' employment record revealed that the managers and their supervisors lacked the professional experience required to do their jobs, the investigator said. 

Further investigation revealed that 10 of those employees had been charged with crimes related to their work at DS Connections, one of which was found guilty of medicaid provider fraud.  

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