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Former Medicaid Claims Biller Sentenced to Prison for Re-directing Medicaid Payments to His Personal Bank Account

PRESS ADVISORY

Former Medicaid Claims Biller Sentenced to Prison for Re-directing Medicaid Payments to His Personal Bank Account

July 31, 2012

Dimitrius Franks, of Fairburn, Georgia, pled guilty last week in Fulton County Superior Court to one count of Medicaid Fraud (O.C.G.A. § 49-4-146.1(b)(1)), three counts of Computer Theft (O.C.G.A § 16-9-93(a)), and three counts of Theft by Taking (O.C.G.A. § 16-8-2). Judge Walter Lovett sentenced Franks on July 25, 2012, to twenty years to serve one in prison. He was also ordered to pay $65,583.52 to the Georgia Department of Community Health and $5181.00 to the Georgia Department of Revenue for a total of $70,764.52 in restitution. 

Franks was independently contracted by a physician’s office, a Medicaid provider, as the company’s office manager and Medicaid claims biller. In his capacity as the Medicaid claims biller, Franks was responsible for submitting all claims for medical services rendered by the office to a Care Management Organization (CMO) for payment. Franks performed a substantial portion of the Medicaid billing from his residence in Fulton County, Georgia.

The indictment against Franks alleged that on or about March 10, 2008, and continuing through on or about October 4, 2008, Franks, unbeknownst to the physician, changed the bank account to which all CMO medical assistance payments were electronically transferred from the office’s business account to his own personal bank account, making Franks the sole recipient of all claims paid by the CMO.  During this time period, Franks submitted numerous false claims to the CMO and unlawfully and intentionally obtained and accepted payments in the approximate amount of $65,583.52, an amount he was not entitled to receive, for medical services allegedly provided by the physician.

Additionally, the indictment alleged that Franks, who was a 1099 contracted employee, filed false W2 forms with the State of Georgia asserting that he had paid taxes for tax years 2006, 2007 and 2008, when he in fact he had not paid any taxes in those three years. Because of his allegedly false tax returns, Franks was able to receive a refund from the Georgia Department of Revenue even though he had not paid taxes in over three years.

Former Assistant Attorney General Jorge Correa prosecuted the case on behalf of the State of Georgia, and Assistant Attorney General Henry A Hibbert presented the case to the court for the plea. The case was investigated by Investigator Johnny Brooks, Investigative Auditor Judith Ann Cooper and Analyst Zwella Boyd, all of the Georgia Medicaid Fraud Control Unit.