On Monday, June 23, 2015, Della Upshaw of Columbus, Ga., pleaded guilty in Muscogee Superior Court to one count of Medicaid Fraud (O.C.G.A. § 49-4-146.1(b)). She also pleaded guilty to one count of Insurance Fraud (O.C.G.A. § 33-1-9), a charge brought by Muscogee County District Attorney Julia Slater. Judge Ronald Mullins sentenced Upshaw to one year in prison, followed by nine years probation and restitution in the amount of $98,344.15.
Upshaw owned Senior Care of Columbus, Inc., and Reaching Out Healthcare, Inc. The companies were enrolled in the Community Care Service Program, a Medicaid program administered by the Georgia Department of Community Health, for senior citizens in need of assistance, including in-home personal care and day health services.
From 2009 until 2011, Upshaw submitted numerous fraudulent claims for and was reimbursed for services that were not provided to patients. An investigation began when it was discovered that Upshaw submitted an extraordinarily high percentage of claims for reimbursement to Georgia Medicaid without any documentation. The investigation revealed that in many instances, Upshaw billed Medicaid on days when patients received no services at all. She also billed for patients who had been discharged.
“Ms. Upshaw’s contract with Georgia Medicaid entrusted her to care for vulnerable senior citizens in need of in-home assistance,” said Attorney General Sam Olens. “Ms. Upshaw violated that contract and robbed Georgia Medicaid by submitting bogus claims for treatment that was never provided to patients. She will now pay for her actions with a prison sentence. I applaud Judge Mullins for treating the crime of Medicaid fraud with the seriousness it deserves.”
Assistant Attorney General Henry Hibbert prosecuted the case on behalf of the state of Georgia. Investigator Ralph Harper, Investigator Judy Cooper, Chief Nurse Investigator Donna Wills and Intelligence Analyst Zwella Boyd, of the Attorney General’s Medicaid Fraud Control Unit, investigated the case with the assistance of the Department of Community Health Office of the Inspector General.