Robin Raveendran, 62, a former Medicaid integrity director who later joined Preferred Family Healthcare, was charged Thursday with two felony Medicaid fraud charges that grew out of the FBI public corruption investigation, the Batesville Guard reports. The charges detail more than $2 million in fraudulent charges.
It develops that the state suspected something was amiss in billing procedures, but the company fought to keep the system in place. The investigation was renewed only after the FBI tipped state officials in late 2016. A lobbyist’s guilty plea in the case, which listed unidentified co-conspirators, had recently pointed a finger at Raveendran, though his name had not emerged publicly.
Among others, the affidavit for the arrest notes that Arkansas paid for more than $140 million more in gruop psychotherapy charges under Medicaid than the next closest state in the region.
Lots more to come, including what the state says about missing this originally and whether, finally, the state will do anything about the money taken.
UPDATE: Preferred Family Healthcare endeavored to distance itself from futher reports of corruption, though it doesn’t address the enormous question about whether it is being paid way too much for it services, even if legal.
As the documents charging Robin Raveendran clearly show, Preferred FamilyHealthcare has been cooperating extensively with this investigation. Raveendran was let go from PFH in 2017. PFH continues to work with government authorities to uncover misconduct by several former leaders and employees of the organization. We are committed to cooperating and providing any
information which will ensure that any individual whose actions may have violated the law are held accountable.
Sadly, these charges show a concerted effort to deceive PFH by Rusty Cranford and a small group of former leaders, who are no longer employed because of those actions. We understand this is an ongoing process and likely not the last action taken against former employees and vendors. We continue to cooperate with authorities as they follow the facts and the evidence, including information we are providing.
The alleged actions of Mr. Raveendran do not reflect the values of PFH. While we cannot change the past misdeeds of others, we are committed to a new path forward by continuing to implement new and thorough processes and procedures. We are grateful to the more than 4,000 employees who continue to provide critical services to individuals throughout Arkansas and the four other states we serve
The Guard’s Angelia Roberts reports that the case was put together by the attorney general’s Medicaid Fraud Division after it was tipped by the FBI public corruption investigators in 2016. The charge was filed by Independence County Prosecuting Attorney Holly Meyer.
Raveendran’s charge, the article says, relates to Raveendran’s work for Health Resources of Arkansas, a mental health group that is part of Preferred Family Healthcare. It’s been enmeshed in multiple federal corruption charges against former executives and legislators. A former executive and lobbyist Rusty Cranford recently pleaded guilty to some $4 million worth of bribery, kickbacks and illicit spending from money that flowed into the agency from Medicaid. Some of the money went to passing a law that established a favorable reimbursement scheme for local mental health agencies under the PFH umbrella. The company still has millions in state business. It claims it has cleaned house of crooked employees. The state has refused to do anything to the agency except say it is monitoring it more closely now.
The Guard said Raveendran oversaw Medicaid billing for Health Resources.
From Roberts’ article:
Fraud Investigator Rhonda Swindle said the MFCU was contacted by the FBI in late 2016 regarding an ongoing public corruption investigation and asked the MFCU to look into possible Medicaid fraud.
The investigation led the unit to a small group of individuals who had been providing lobbying and consulting services connected directly or indirectly with Rusty Cranford.
Cranford, the affidavit states, pleaded guilty in federal court to operating a criminal enterprise in Arkansas where he was able to get a number of Medicaid providers, state legislators along with former and present state employees to assist him in the criminal activities.
Some assisted knowingly, while others did not, according to the affidavit.
“This affidavit concerns the conduct of one of Cranford’s closest associates, Robin Raveendran.”
The scheme, investigators say, was directed by Raveendran whom they claim is the “key leader,” although the state does not believe he acted alone.
“Most of the claims were created and processed by the Preferred Family Health, Inc. Batesville office.”
The affidavit for arrest lays out how the fraudulent Medicaid billing took place. A chart showing those numbers lays out how Raveendran decided to directly bill Medicaid.
The affidavit also lays out how Raveendran was an expert in Medicaid rules, regulations and billing.
Raveendran worked for DHS from 1984 until 2014. According to an on-line biography, in May 2004 he became the chief program administrator for DHS’s Program Integrity Unit and was appointed by Gov. Asa Hutchinson to the Legislative Criminal Justice Oversight Task Force in April 2015. That group advocated mental health care changes (lauded by many) that opened up Medicaid mental health services to, for example, parolees. Many endorsed the idea. Some saw it as enhancing profit opportunities for certain health-care provfiders.
The article continues:
Raveendran reported that he had been invited to participate in the National Fraud Symposium hosted by the White House to share ideas from a state’s perspective on reducing improper payment and improving quality of service. …..
In 2014 he became the executive director for Preferred Family Health. He was terminated from PFH on Dec. 1, 2017.
The affidavit for the arrest details the scheme, the newspaper said. Raveendran devised “a productivity model with compensation packages for billing so many hours per month. Staff members were encouraged to maximize their billable number of hours per week and they would be compensated.”
(This echoes complaints we’ve received from anonymous PFH employees about ongoing practices aimed at maximizing billing.)
According to the affidavit, Raveendran allowed billing that shouldn’t have been billed and charges were mischaracterized when submitted for reimbursement.
In all, the charge alleges 18,523 illegal claims were submitted for 549 clients between Jan. 1, 2015 and July 31, 2017. That meant a total of illegal claims of $2.13 million. It appears a subsequent amendment for one class of patients raised the total to $2.27 million billed for 20,109 cases.
The information also noted that recipients were provided services by providers that did not have the credentials required by the Medicare program. HRA received more than 90 percent of their cross-over reimbursement dollars from Medicaid as opposed to other providers.
“Perhaps the best evidence that Raveendran knew what he was doing is the battle he fought along with Cranford to keep the Medicaid vulnerabilities he exploited in place.”
In 2014, an internal report revealed a significant vulnerability and both Raveendran and Cranford fought proposed changes [by the Medicaid inspector general]. “This event occurred near the time when Raveendran initiated the billing fraud at PFH.”
Also noted was how much this group was being paid for “Group Psychotherapy” service by lesser qualified therapists. From Jan. 1, 2015, to Oct. 31, 2017, that amount came to $729,766.85.
When the Medicaid Inspector General, Elizabeth Smith, recommended caps, that proposal was aggressively attacked by Cranford and Raveendran. The Cranford Coalition had at least 30 face-to-face meetings and made over 20 conference calls to legislators and others.
“What Elizabeth Smith and most of the legislature did not know during the heated debate was that Raveendran was engaged in an ongoing Medicaid fraud scheme that targeted the very vulnerabilities Cranford and Raveendran were fighting to keep in place.”
Circuit Judge Tim Weaver set Raveendran’s bond at $250,000. Jail records indicate he’s posted the bond.
Here’s the affidavit for Raveendran’s arrest warrant. It’s dense stuff and my copy is jumbled in page order and copying, but if you have Acrobat you can flip pages. It includes avoiding Medicare reimbursement for more liberal Medicaid reimbursement, as well as fraudulent activities.