A former billing director for behavioral health provider Preferred Family Healthcare has been charged with Medicaid fraud in Independence County.
Arkansas Attorney General Leslie Rutledge announced the arrest of Helen Balding, 47, of New Braunfels, Texas, formerly of Fayetteville, on two counts of Medicaid fraud. She’s accused of causing Arkansas to overpay Preferred Family Healthcare $2.2 million from January 2015 to October 2017. Here’s the affidavit in her arrest.
Update: The scheme is the same one described in an earlier Medicaid fraud case filed against PFH executive Robin Raveendran, who is accused of defrauding the state of $2.2 million through improper billing practices coordinated through the PFH affiliate in Batesville. Rutledge’s news release said Balding was an accomplice of Raveendran and others “known and unknown.”
Prosecutors say Raveendran, a former program integrity director for the state Department of Human Services, used his intimate knowledge of medical billing to devise a method to overcharge Medicaid for certain services that should have been paid by Medicare. (Because Medicaid paid higher rates than Medicare for the services in question, this resulted in more money for PFH — and higher costs to the public.)
The affidavit in Balding’s arrest says she was complicit in the scheme and earned at least $339,000 over a two-year period from PFH and two other entities, including a firm operated by indicted lobbyist Rusty Cranford.
Balding was first hired in 2009 by Dayspring, an Arkansas affiliate of the nonprofit that later became PFH. In 2014, that nonprofit also acquired a second Arkansas provider called Health Resources of Arkansas. After the merger, Balding trained the Batesville staff at Health Resources of Arkansas on billing procedures, including the fraudulent method described above. Balding told prosecutors that Raveendran “gave the directive” to
The affidavit says that Balding knew what she was doing was wrong. “She stated that she knew this was incorrect and initially disputed the directive. Regardless, she instructed the HRA staff to illegally bill the … claims according to PFH emails dated August 2014,” it says. Meanwhile, PFH’s other Arkansas affiliate continued to bill claims properly. Balding “purposely and knowingly instructed the two divisions of PFH (HRA and Dayspring) to bill the … claims differently,” the affidavit says. It describes Balding as “an experienced billing supervisor” who knew how to properly bill Medicaid.
Bank records show Balding earned “at least $339,000 from January 1,
Balding was initially “mostly cooperative” in the investigation, the affidavit continues, though she “minimized her role” in the scheme. “[H]owever, approximately one month ago, Balding stated she moved to Texas and then stopped communicating with the [Medicaid Fraud Control Unit.]”
PFH has been cut off from the Arkansas Medicaid program as a result of a federal corruption probe that uncovered kickbacks and
When Raveendran was arrested, PFH issued a statement saying it had been “deceived” by a “small group of former leaders” and it was rooting them out and cooperating with investigators.