Authorities say a Columbus woman running two adult healthcare programs bilked Medicaid out of $269,000 over two years by filing undocumented claims for services she did not provide.
A Muscogee County grand jury this week indicted Della Upshaw on two counts of Medicaid fraud and one of felony theft by taking. Investigators with the Georgia Attorney General’s Medicaid Fraud Control Unit allege Upshaw’s two companies, Senior Care of Columbus Inc. and Reaching Out Healthcare Inc., were reimbursed for false claims submitted between Oct. 1, 2009, and Dec. 1, 2011.
They said Upshaw’s Senior Care of Columbus Inc. contracted with Medicaid’s Community Care Services Program through the Georgia Department of Community Health to provide “in-home support services,” which the indictment describes as “a combination of basic personal care services and homemaking services for those vulnerable individuals who are medically frail and are unable to care for themselves and unable to function independently.”
Investigators said they found that Upshaw electronically had submitted and been reimbursed for serving clients who weren’t in their homes or otherwise were unavailable at times cited in Upshaw’s claims. Some claims were filed for clients after they were discharged from Upshaw’s program, authorities said.
Through Reaching Out Healthcare Inc., Upshaw offered a Medicaid “adult day program,” which according to the indictiment is intended to provide “social, health, and rehabilitative services to individuals who are functionally impaired” and “support individuals living with with chronic illness” or recovering from acute illnesses or injuries. Upshaw submitted claims for clients who were not at the day health center during the times cited, authorities said.
According to the attorney general, an investigation into Upshaw’s companies started “when it was discovered that Upshaw submitted an extraordinarily high percentage of claims without any documentation.”