Question

Mental Health Clinic Owner Pleads Guilty to Making a False Claim to Medicaid St. Louis, MO – Naim Muhammad, 56, of St. Charles, MO, pled guilty to one count of making a false claim to Medicaid. Mr. Muhammad appeared today before U.S. District Judge Audrey G. Fleissig who accepted his plea and set sentencing for February 28, 2020. According to the plea agreement, Mr. Muhammad was the President of Community Behavioral Health (“CBH”). CBH maintained an office in the City of St. Louis, Missouri. Mr. Muhammed had no psychiatric training or license. Mr. Muhammed billed the Missouri Medicaid program for mental health therapy services to a patient identified by initials W.W. Mr. Muhammad told Medicaid that a licensed provider with the initials D.P. had provided the therapy to W.W. on June 21, 2017. However, Mr. Muhammad’s statements were false and fraudulent in that patient W.W. was not treated by the licensed provider D.P. on June 21, 2017, the date of service shown in defendant’s therapy records for W.W. Mr. Muhammad’s statements were material to the Missouri Medicaid program because the program does not pay for services not actually provided to the patient and does not pay for mental health services provided by unlicensed individuals. The Indictment in this case further alleges that Mr. Muhammad repeatedly billed the Missouri Medicaid program for therapy services allegedly provided on dates when the patient was actually deceased, and, therefore, unable to receive any services. For example, W.W. died on June 8, 2017, before the alleged June 21, 2017 session. This charge carry a maximum possible penalty of five years imprisonment, a fine of $250,000 or both imprisonment and a fine. In determining the actual sentences, a judge is required to consider the U.S. Sentencing Guidelines, which provide recommended sentencing ranges. The Office of Inspector General investigated this case for the U.S. Department of Health and Human Services and the Medicaid Fraud Control Unit of the Missouri Attorney General’s Office, with assistance from the Division of Professional Registration of the Missouri Department of Commerce and Insurance.

What was significant about the fraud and abuse issue(s) you learned about? What attempts were made, or could be made, to stop the fraud or abuse? What was the role of the Office of the Inspector General in addressing fraud or abuse in the case(s) you watched?

Answer 1

Part one Signific about the fraudulent.

Mr Naim muhhamed was having no psychiatric training and license .With this he qualified for president of community behavior health.

He also lied about the treatment of W.W being treated by D.P which W.W wasn't.

Missouri Medicaid program doesn't provide services which given to the patient W.W

Program doesn't pay for services provided by unlicensed individual for mental health patient .

Mr Muhhamed also repeatedly billed .These valid points

Gives significance of the fraudulent.

Part Two

Since the fraud is a very big and done with clever intention.

The remedial measures can be taking from the root itself. It should be mandatory that person with no psychiatric training and license can be president of Community behavior health.

There should be stamp of registered medical practioner so that patient should also know that he was being treated by qualified individual.

Health program provider should also have record of health service provider with their qualification .

Part3

Office of the inspector general played a pivotal role in addressing the case .

It would have been a futile attempt without their help .They were the key information provider .

They had the close look on every single details regarding treatment and patient details and also the health service provider.

They also had a key role in helping the judge to give actual sentence according to U.S sentencing guidelines.