I hate it when I see fraud against the Government, but I hate it even more when I see fraud against kids. I want to congratulate my friend and fellow whistleblower lawyer Ross Brooks for some great work he did in a suit that tried to stop some really callous treatment of schoolchildren - special education kids, at that.
Ross is a qui tam lawyer, like I am. Ross was representing Dana Ohlmeyer, a social worker who worked for the NYC Department of Education. Ms. Ohlmeyer discovered that the City of New York was pretending to offer psychological counseling services to special ed kids - but it was not really bothering to offer the counseling.
I don't know all the details of why these kids needed counseling, but apparently the need for these particular kids was strong enough that Medicaid was paying the Department of Education $223 a month to give each student two psychological counseling sessions. In other words, Medicaid was paying NYC a pretty steep price of $111.50 per session to counsel these kids.
NYC told Medicaid that it was giving these counseling sessions. It stuck its hand right out and collected all the money it was entitled to get for giving these counseling sessions. The problem was, NYC's own records showed that the students were not actually receiving the counseling they were supposed to get. The U.S. Department of Justice press release on the case, which settled yesterday, said New York City claimed it gave one poor kid counseling for 15 months between 2000 and 2003. The claim was false for 12 of those 15 months, because the kid got either 1 or 0 sessions during those 12 months.
How many times did NYC do this? Pretty darn many. NYC is paying the U.S. Government $1,375,000 to settle the claim.
I don't know the details of the case, because of course the personal details of the kids are not being released. However, you can imagine all sorts of reasons why these special ed kids needed the counseling. Medicaid would not have paid for it in the first place if these kids had not had a prescribed need for help.
So you have to figure that somewhere in New York City there was a kid who was dealing with being made fun of because he was "different" from the other kids. Another kid was trying to process the fact that he was handicapped - mentally or physically - because he had been abused by somebody he loved. Some other child had a serious mental illness and needed to talk about why she acted differently, and learn how she ought to interact with her peers or her teachers.
Whatever the child's story, NYC gave the kid nada. Medicaid paid NYC for the counseling, but NYC just did not provide it.
The United States Attorney for the Eastern District of New York, Loretta Lynch, made a very good point in the Government's press release: "When Medicaid shells out scarce dollars for services that are not provided, both the students in need of psychological support and the public fisc are harmed."
Hats off to social worker Dana Ohlmeyer, who saw what was happening and stood up for these special education schoolchildren. Congratulations also to Ross Brooks for his great work in bringing this conduct to the attention of the Government, and to U.S. Attorney Loretta Lynch and the team she marshalled, including Assistant United States Attorney Michael J. Goldberger and Department of Health and Human Services Office of Inspector General Special Agent Elysia Doherty, for the work they did in resolving the case.
I was disappointed to see that Ms. Ohlmeyer received just 15% of the amount the Government got, because that is the absolute minimum amount set by Congress. In my view, this case rang the bell in terms of fraud, because what was happening in NYC was hurting not just the federal government, but also a very vulnerable population. Surely we ought to do everything we can to encourage whistleblowers like Ms. Ohlmeyer.