Note to Florida Scammers: Exclusion Status Matters to Prosecutors

Posted by Joe Stefansky on October 1, 2021 in Florida,

In April of 2021, defendants Stephanie Fleming and Helen Storey were convicted of multiple counts of health care fraud in federal district court in Florida. The defendants were found guilty of conspiracy to commit healthcare fraud, multiple counts of healthcare fraud, one or more counts of false statements relating to healthcare matters, and two counts of aggravated identity theft. Fleming was also found guilty of making false statements in connection to healthcare matters.

Healthcare fraud in Florida is hardly a rarity.  In fact, the Sunshine State is a hotbed of fraud activity. Its reputation as a land of opportunity draws scammers and opportunists from across the country. Therefore, what made the case against Storey and Fleming somewhat unique was the focus of the prosecutors on the Defendant’s disregard for federal and state exclusion.

“Convicted fraudsters Storey and Fleming fraudulently billed the Medicaid program for bogus claims. The pair ignored an exclusion from all federal health care programs, thus stealing from this taxpayer-funded safety net program that is designed to provide legitimate health services to vulnerable patients,” said Special Agent in Charge Omar Pérez Aybar. “Our investigators will continue to aggressively investigate such bad actors to hold them accountable and to send a warning to others tempted to loot from federal health care programs.”

The facts of the case are unremarkable. Storey owned and operated North Florida Mental Health (NFMH), a Tallahassee-based counseling center, and employed Fleming as a licensed mental health counselor. Evidence presented showed that between April 15, 2016 and December 31, 2017, Storey and Fleming improperly obtained, or attempted to obtain, more than $250,000, from Florida Medicaid by submitting fraudulent claims through NFMH.

As noted in court records, Fleming had a significant criminal history.  On November 9, 2015, Stephanie Fleming, a Licensed Mental Health Counselor in New Jersey (who was also licensed in Florida) was arrested on a 43-count indictment returned in New Jersey. The New Jersey indictment charged violations of state statutes, including multiple counts of second-degree health care fraud, third-degree Medicaid fraud,fourth-degree forgery, and a single count of theft by deception. The New Jersey indictment alleged that between March 1, 2015 and July 1, 2015, Defendant Fleming submitted fraudulent claims to New Jersey’s Medicaid Program for counseling and therapy sessions with minors.  

On February 2, 2016, Fleming pleaded guilty to one count of Making or Causing False Statements to a Medicaid Assistance Program, a third degree felony offense under New Jersey law. Defendant Fleming failed to report her guilty plea within 30 days to the Florida Department of Health (hereinafter “DOH”) as she – a Florida licensed mental health counselor – was required to do under Florida law. Fleming was sentenced to one-year probation, 2 days jail with credit for 2 days, $9,045 in restitution, fines and penalties, and a 5- year debarment from Medicaid in any state. With respect to the 5-year debarment from Medicaid in any state, on the same day as her sentencing, Defendant Fleming separately executed a written agreement which provided in part:

That, Stephanie Fleming, shall be debarred for a period of five (5) years, effective April 15, 2016, from participation in any program administered in whole or in part by the New Jersey Medical Assistance and Health Service Program (Medicaid) and any other federally or state-funded health insurance or prescription assistance program.

Notwithstanding her conviction and guilty plea, Fleming continued to misrepresent her legal status.  After her guilty plea in New Jersey, but prior to her sentencing hearing, Defendant Fleming applied with WellCare to be a Florida Medicaid provider. In her application to WellCare,  Defendant Fleming falsely stated that she never pled guilty to illegal conduct within the past 10 years, and that she had not pled guilty to a felony. After pleading guilty to a felony in New Jersey, Defendant Fleming also submitted a Practitioner Network Application to Beacon Health Strategies in which she falsely attested that she had not pled guilty to illegal conduct within the past ten years, and that she had not pled guilty to a felony.

Helen Storey, a close friend of Fleming, submitted a Provider Enrollment application to the Florida Agency for Healthcare Administration (hereinafter “AHCA”) for her business, North Florida Mental Health, LLC (hereinafter “NFMH”), to receive Medicaid reimbursement for the mental health services provided to its patients. The application was submitted to AHCA on or about February 10, 2016 – 8 days after Fleming entered her guilty plea in New Jersey. As part of NFMH’s enrollment application, Storey informed AHCA that Defendant Fleming was the manager of NFMH. Storey falsely certified that neither she nor Fleming had: (1) pled guilty to a felony, (2) disciplinary action taken against any of her business and professional licenses held in Florida and any other state, and (3) surrendered a business or professional license in Florida and any other state. However, prosecution evidence supported that she was aware of Fleming’s New Jersey arrest and sentencing hearing.

The prosecution’s case rested in large part on false statements by both Storey and Fleming on Storey falsely Medicaid/MCO applications and failure to notify AHCA of felony conviction/debarment from Medicaid. As noted above, Defendant Fleming falsely certified to two Florida Medicaid MCOs, WellCare and Beacon Health Strategies, that she was not convicted of a felony. Further, she failed to notify the DOH of her conviction as required by law and the fact that she was debarred from participating in any state Medicaid program for five years.

As noted above, Defendant Storey falsely certified that neither she nor any owner/operator of NFMH, which included Defendant Fleming, had been convicted of or pled to a felony. Because of these false statements and omissions to Florida Medicaid and its MCOs, and to DOH, all reimbursement claims that were submitted to Florida Medicaid for services rendered by NFMH and Defendant Fleming were the product of fraud.

Sentencing of Storey and Fleming was scheduled to occur in August 2021.  In light of Fleming’s ongoing disregard for the law, especially on the heels on her New Jersey conviction, it is unclear what sentences these defendants may face. However, what is clear at this point is that Fleming’s debarment, and Storey’s decision to hire a debarred provider and then misrepresent Fleming’s criminal history were significant factors in the outcome of this case.

Check out this great resource for all questions on the Florida OIG Exclusion List.

About Joe Stefansky

About Joe Stefansky

Joe Stefansky has a keen sense of business opportunities in complex problems, using technology to transform difficulty into efficiency. The CEO and founder of Streamline Verify specializes in solving compliance, legal and administrative issues through intuitively designed software that reduces costs and saves time.

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