In June, the Department of Health Care Finance (DHCF), the District’s Medicaid Agency, reported suspected provider fraud to the District’s Office of the Inspector General’s Medicaid Fraud Control Unit (MFCU), United States Attorney’s Office for the District of Columbia and the Federal Bureau of Investigation (FBI). After reviewing and auditing Medicaid claims and patient files submitted by Speqtrum Home HealthCare Service (Speqtrum), DHCF today moved to remove Speqtrum as a Medicaid provider and seeks to recoup over $10 million in possible fraudulent claims.

“We are glad to have collaborated with our local and federal partners,” said Dr. Julie Hudman, Director of the Department of Health Care Finance. “It’s a new day at DHCF. We are building capacity and quality controls to ensure that our most vulnerable populations receive the services they are entitled to receive without compromising the integrity of our program.”

In May, DHCF staff conducted an audit of Speqtrum patient files and Medicaid claims from over a three-year span (October 1, 2005 – April 29, 2009). DHCF staff reviewed these samples and looked to verify that the health care services were provided to a specific Medicaid-eligible beneficiary and that the services are both covered and reimbursable under the Medicaid program.

In the audited sample, DHCF staff found claims and patient files that were unsupported and didn’t contain proper documentation including, but not limited to:

• Description and dates of services rendered, including the name of the personal care aide performing the services
• Documentation of each supervisory visit of the registered nurse including signed and dated clinical progress notes
• Physician signed plan of care
• Skilled nurse visit sheets

DHCF has moved forward to terminate Speqtrum (which will become effective September 21, 2009 after due process and appeals are completed) for violation of the District of Columbia Municipal Regulations by:

• Knowingly making false statements or misrepresentations of material fact in claiming or in determining the right to payment
• Repeatedly submitting claims which overstate the level or amount of health provided
• Failing to develop and maintain patient care records which document the nature, extent, and evidence of the medical necessity of health care provided

“As with the national crackdown on Medicaid fraud the District of Columbia is following suit,” said Dr. Hudman.  “In these tough economic times, saving a dollar means so much more and could potentially provide services for another person in need.”

Medicaid and Medicare beneficiaries receiving services from Speqtrum will be allowed to select another home health provider and are encouraged to call the District’s Health Care Ombudsman at 1-877-685-6391 and/or the District’s Aging and Disabilities Resource Center (ADRC) at 1-877-919-2372.

Yesterday, the FBI, agents from the United States Department of Health and Human Services, and investigators from the MFCU searched and seized materials from the Speqtrum offices at 3019 Georgia Avenue, NW, Washington, DC, and in Maryland.

Anyone who has more information or would like to report possible Medicaid waste, fraud and abuse should contact the District’s Medicaid Fraud Hotline at 1-877-632-2873.

View the List of DHCF Home Health Agencies*.

Note to Beneficiaries that use Speqtrum (English, Spanish, French, Amharic, Vietnamese, Chinese Traditional, Korean)*

Letter to Beneficiaries that use Speqtrum (English)

Letter to Beneficiaries that use Speqtrum (Chinese Traditional)

Letter to Beneficiaries that use Speqtrum (Korean)*