A former clerk who found a way to illegally bill Medicaid helped facilitate $3 million in improper billings for the Missouri-based nonprofit caught in Arkansas' political corruption scandal, according to a plea deal struck Monday.
Vicki Chisam, 66, was the lowest-ranking of three former Preferred Family Healthcare workers charged by Arkansas Attorney General Leslie Rutledge's office in the scheme.
The other two, including former executive Vice President Robin Raveendran, have not yet pleaded to related state charges. Raveendran has pleaded guilty to a federal conspiracy charge.
Initially charged with felony Medicaid fraud, Chisam pleaded guilty to participating in a conspiracy as part of the deal, a lesser felony. The agreement was signed Monday and presented in Independence County Circuit Court in Batesville, according to Rutledge's office.
Rutledge's office recommended a three-year suspended prison sentence, citing Chisam's cooperation in the investigation. Under the terms, Chisam would serve prison time if she violates the conditions of the agreement or stops cooperating with investigators.
Chisam worked for Health Resources of Arkansas, a community mental health center with outpatient behavioral health clinics, which was acquired by Preferred Family in 2014.
After the merger, according to Chisam's plea agreement, Raveendran "specifically directed" her to find a way to bill Medicaid without first trying Medicare, as the program's rules required.
Medicaid is the state and federally funded insurance program for low-income residents and children, and it is supposed to be the "payor of last resort." Medicare is the federal program for the elderly and disabled.
Some beneficiaries qualify for both programs, which have different rules, including what types of services are allowed and what credentials providers must have to administer the services.
Software used by Preferred Family was designed to reject Medicaid claims for dual-eligible beneficiaries unless the biller documented that Medicare had already been tried, the agreement says. Medicaid is designed to pay the co-insurance and deductibles for these clients.
"When they attempted to bill the [claims] straight to Medicaid as directed, they discovered that the function could not be performed without first falsifying the data within the claims submitted," the plea deal says.
Chisam learned how to solve the problem and "showed Raveendran and others," says the deal, acquired Monday evening.
"Chisam was an active participant in Preferred Family Healthcare's culture of corruption," Rutledge said in a statement. "I will hold those accountable who abuse our State's safety nets for their own personal gain."
Chisam's attorney could not immediately be reached for comment.
Raveendran, 63, pleaded guilty last month in federal court to one count of conspiring with Preferred Family executives to pay more than $35,000 in bribes to former Arkansas Sen. Jeremy Hutchinson.
Hutchinson, later last month, pleaded guilty to three federal charges, including accusations that he accepted bribes in that case.
Raveendran was charged in the Independence County case with the Class A felony Medicaid fraud. Class A felonies are punishable by six to 30 years in prison.
Helen Balding, the former billing director, is charged with two felony counts of Medicaid fraud. She is accused of instructing her staff to illegally bill the program at Raveendran's direction.
Neither Raveendran nor Balding have entered pleas to the state charges.
Arkansas suspended Preferred Family from participating in the Medicaid program after Raveendran's arrest in June 2018. The nonprofit later sold its network of Arkansas clinics to Hot Springs-based Quapaw House Inc.
Preferred Family, which continues to operate in multiple states, has said it has cooperated with federal and state investigations and expelled the former leaders who were caught up in wrongdoing.
Several of the former executives have pleaded guilty to assorted federal charges.
Its former chief financial officer and chief operating officer are scheduled to go to trial in 2021 on more than 20 federal charges each. They have pleaded innocent.
Metro on 07/23/2019