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Former CEO of Virginia Home Health Care Provider Sentenced to Prison for Government Fraud

March 31, 2016

Office Affiliation: The Office of Investigations

From the U.S. Attorney’s Office, Western District of Virginia:

CHARLOTTESVILLE, VIRGINIA – The former CEO of a home health care provider that operated in the Western District of Virginia, and who previously pled guilty to a pair of federal criminal charges, was sentenced today in the United States District Court for the Western District of Virginia in Charlottesville, announced United States Attorney John P. Fishwick Jr. and Virginia Attorney General Mark R. Herring.

Amanda Moye Randolph, 43, of Palmyra, Virginia, pled guilty in October 2015 to one count of theft of public money and one count of falsification of records in relation to a federal investigation. Today in District Court, Randolph was sentenced to eight months in federal prison, to be followed by three years of supervised release, the first eight months of which must be served in some alternate form of incarceration.  Randolph was also ordered to pay $136,574 in restitution.  

“Medicaid and other social programs are in place to help those in our communities who are truly in need of assistance,” United States Attorney John P. Fishwick said today. “When individuals like Ms. Randolph steal from these important social programs, they must be held accountable. I am grateful to be able to work with the Office of the Attorney General on this case, as always, the Medicaid Fraud Unit did great work in bringing this case together.”

“We will always work to hold providers accountable for fraudulent and illegal business practices that steal from taxpayers and from vulnerable individuals who rely on these important programs for medical care. Our close relationships with state and federal partners, including the U.S Attorney’s office and the Department of Medical Assistance Services, are key to successfully pursuing these cases,” said Virginia Attorney General Mark R. Herring.

According to evidence presented at previous hearings by Assistant United States Attorney Ronald Huber, Randolph was the CEO of Karlise In-Home Care, a Medicaid home health care provider, from April 2008 to June 2014. From around December 2008 to April 2014, Randolph knowingly concealed her employment at Karlise from the United States Social Security Administration and the United States Department of Health and Human Services during the application for, and continued receipt of, disability benefits and supplement security income benefits. An accounting completed by those two agencies concluded that Randolph received $80,735 in connection with these fraudulent schemes.

In January 2013, the Medicaid Fraud Control Unit of the Virginia Office of the Attorney General initiated a criminal investigation of Karlise following a complaint that Randolph had fabricated missing documentation from patient files. In furtherance of this investigation, the Department of Medical Assistance Services [DMAS] conducted a series of on-site audits of Karlise and requested to examine specific patient files that had previously been submitted for billing. Prior to turning these files over to auditors, Randolph examined these forms, determined that they were missing required information and/or signatures and, in turn, forged this information in order to prevent DMAS auditors from discovering discrepancies in Karlise patient files.

Randolph was aware that if discrepancies were discovered by DMAS, Karlise would in turn be required to reimburse Medicaid for the incorrectly documented services.

A subsequent review by the Medicaid Fraud Control Unit for the Virginia Office of the Attorney General has concluded that Medicaid incurred a loss of $55,838 as a result of the falsified documentation in Karlise patient files.

The investigation of the case was conducted by Medicaid Fraud Control Unit for the Virginia Office of the Attorney General, the Department of Medical Assistance Services, the Department of Health and Human Services, and the Social Security Administration.  Assistant United States Attorney Ronald Huber prosecuted the case for the United States.

CHARLOTTESVILLE, VIRGINIA – The former CEO of a home health care provider that operated in the Western District of Virginia, and who previously pled guilty to a pair of federal criminal charges, was sentenced today in the United States District Court for the Western District of Virginia in Charlottesville, announced United States Attorney John P. Fishwick Jr. and Virginia Attorney General Mark R. Herring.

Amanda Moye Randolph, 43, of Palmyra, Virginia, pled guilty in October 2015 to one count of theft of public money and one count of falsification of records in relation to a federal investigation. Today in District Court, Randolph was sentenced to eight months in federal prison, to be followed by three years of supervised release, the first eight months of which must be served in some alternate form of incarceration.  Randolph was also ordered to pay $136,574 in restitution.  

“Medicaid and other social programs are in place to help those in our communities who are truly in need of assistance,” United States Attorney John P. Fishwick said today. “When individuals like Ms. Randolph steal from these important social programs, they must be held accountable. I am grateful to be able to work with the Office of the Attorney General on this case, as always, the Medicaid Fraud Unit did great work in bringing this case together.”

“We will always work to hold providers accountable for fraudulent and illegal business practices that steal from taxpayers and from vulnerable individuals who rely on these important programs for medical care. Our close relationships with state and federal partners, including the U.S Attorney’s office and the Department of Medical Assistance Services, are key to successfully pursuing these cases,” said Virginia Attorney General Mark R. Herring.

According to evidence presented at previous hearings by Assistant United States Attorney Ronald Huber, Randolph was the CEO of Karlise In-Home Care, a Medicaid home health care provider, from April 2008 to June 2014. From around December 2008 to April 2014, Randolph knowingly concealed her employment at Karlise from the United States Social Security Administration and the United States Department of Health and Human Services during the application for, and continued receipt of, disability benefits and supplement security income benefits. An accounting completed by those two agencies concluded that Randolph received $80,735 in connection with these fraudulent schemes.

In January 2013, the Medicaid Fraud Control Unit of the Virginia Office of the Attorney General initiated a criminal investigation of Karlise following a complaint that Randolph had fabricated missing documentation from patient files. In furtherance of this investigation, the Department of Medical Assistance Services [DMAS] conducted a series of on-site audits of Karlise and requested to examine specific patient files that had previously been submitted for billing. Prior to turning these files over to auditors, Randolph examined these forms, determined that they were missing required information and/or signatures and, in turn, forged this information in order to prevent DMAS auditors from discovering discrepancies in Karlise patient files.

Randolph was aware that if discrepancies were discovered by DMAS, Karlise would in turn be required to reimburse Medicaid for the incorrectly documented services.

A subsequent review by the Medicaid Fraud Control Unit for the Virginia Office of the Attorney General has concluded that Medicaid incurred a loss of $55,838 as a result of the falsified documentation in Karlise patient files.

The investigation of the case was conducted by Medicaid Fraud Control Unit for the Virginia Office of the Attorney General, the Department of Medical Assistance Services, the Department of Health and Human Services, and the Social Security Administration.  Assistant United States Attorney Ronald Huber prosecuted the case for the United States.

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