On August 13, 2013, David Brannon, of Gainesville, Ga., pled guilty to one count of Medicaid Fraud (O.C.G.A. § 49-4-146.1(b)) in Hall County Superior Court. Brannon was paid almost $150,000 by Georgia Medicaid as a result of fraudulent billing.
Brannon operated Brannon Pediatrics, a Gainesville, Ga., company that was enrolled in Georgia Medicaid to provide mobile therapy services to children. He was in charge of the billing, which included submitting claims for reimbursement to Medicaid. Brannon Pediatrics serviced approximately 100 patients and averaged six therapists on the payroll.
The fraud was discovered when a therapist formerly employed by Brannon Pediatrics reported to the State that Brannon had submitted claims using her assigned provider number for services she did not provide. The therapist also reported that after leaving the company, Brannon continued to submit claims under her provider number. Additionally, the therapist told the State that Brannon had “upcoded” therapy claims, meaning he billed for services that had higher reimbursement rates than the services actually rendered. Other therapists’ records showed similar fraudulent activity.
At an onsite audit in July, 2011, Brannon admitted to billing Medicaid from a scheduling sheet without knowing whether the scheduled services had been rendered; not advising Medicaid when services billed had not been rendered; and submitting “upcoded” billing reflecting higher level procedure codes, when lower level procedure codes were performed, documented and submitted by the therapist. He was aware that the “upcoded” procedure code had a higher reimbursement rate than the lower level procedure code.
Judge Kathlene F. Gosselin sentenced Brannon under the First Offender Act to five years probation, a $2000 fine and 100 hours of community service. The defendant has already paid full restitution of $146,367.
Assistant Attorney General Henry A. Hibbert prosecuted the case on behalf of the State of Georgia. The investigation was conducted by Investigator Tonia Medlin, Forensic Analyst Kim Smith and Intelligence Analyst Kirste Young of the Georgia Medicaid Fraud Control Unit, with the assistance of Investigator Kevin Banks of the Department of Community Health’s Program Integrity Unit.