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Birmingham psychologist pleads guilty to defrauding Alabama Medicaid Agency

Brandon Moseley

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Sharon D. Waltz agreed Thursday to plead guilty to a one-count charge of defrauding the Alabama Medicaid Agency by filing false claims for counseling services that were not provided.

U.S. Attorney Jay E. Town, U.S. Department of Health and Human Services-OIG Special Agent in Charge Derrick L. Jackson, and Alabama Attorney General Steve Marshall announced the guilty plea on Thursday.

Waltz, age 50, operated Capstone Medical Resources in a number of locations around Alabama, with its primary office in Birmingham.
Among other services, Waltz provided individual and group counseling sessions for at-risk youth. The information charges that many of the services billed to the Alabama Medicaid Agency were never performed.

Waltz has agreed to plead guilty to conspiracy to defraud Medicaid of at least $1.5 million and has agreed to pay $1.5 million in restitution to Medicaid.

“The greed of this defendant deprived mental health care to many at-risk young people in Alabama, with the focus on profit rather than the efficacy of care,” Town said. “The costs are not just monetary, but have social and health impacts on the entire Northern District. This prosecution, and this investigation, demonstrates what is possible when federal and state law enforcement agencies work together.”

“This defendant was entrusted to provide essential mental health care for young people who were at risk, and to provide these services through an agency with scarce resources for vulnerable Alabamians who are truly in need,” said Attorney General Marshall. “Her actions demonstrate a callous abuse of this trust and a fraud of staggering proportions against the Alabama Medicaid Agency and the taxpayers of our state. Thankfully, the vigilance of this agency served to protect public funds from further misuse and she has been held to account and punished for her crimes.”

“Stealing taxpayer dollars meant for vital community services will not be tolerated,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “The OIG will continue to work with our partners at the Alabama Medicaid Fraud Control Unit to ensure that fraud schemes such as these are identified and the perpetrators punished.”

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An investigation was initiated by the Program Integrity Division of the Alabama Medicaid Agency after an audit showed that Waltz’s billings to the Medicaid Agency had increased from $99,000 in 2015 to more than $2.2 million in 2017.

The Program Integrity Division referred its findings to the Attorney General’s Medicaid Fraud Control Unit after Waltz submitted falsified records during the Program Integrity audit.

A subsequent investigation was conducted by the Medicaid Fraud Control Unit and the Office of Investigations of the U.S. Department of Health and Human Services Office of Inspector General. This investigation determined that the majority of claims submitted by Capstone during 2016 through 2018 were fraudulent and that Waltz submitted and directed her employees to submit claims for counseling services that never occurred, and in some instances for individuals, including family members and friends of employees, who never received services at all.

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The U.S. Department of Health and Human Services OIG, the Alabama Attorney General’s Medicaid Fraud Control Unit, and the Program Integrity Division of the Alabama Medicaid Agency, investigated the case, which Assistant U.S. Attorney J.B. Ward and Assistant Attorney General Bruce Lieberman, working as a Special Assistant U.S. Attorney, are prosecuting.

According to the Office of the Inspector General at the U.S. Department of Health and Human Services, in 2016 the Alabama Attorney General’s Medicaid Fraud Control Unit (MFCU) conducted 62 Medicaid fraud investigations, returned 23 indictments, and 11 civil settlements/judgements. The unit’s eight member staff recovered $17,034,541 at a cost of just $1,379,311. By comparison Mississippi’s MFCU has a staff of 35, conducted 521 investigations, returned 54 indictments, 64 convictions, 14 civil settlements/judgement, and recovered $19,821,844 at a cost of $3,406,060. Georgia’s MFCU has a staff of 44, conducted 495 investigations, returned 19 indictments, 15 convictions, 18 civil settlements/judgement, and recovered $31,571,210 at a cost of $4,719,262. Tennessee’s MFCU has a staff of 36, conducted 273 investigations, returned 35 indictments, 44 convictions, 22 civil settlements/judgement, and recovered $105,835,521 at a cost of $4,828,604. Florida’s MFCU has a staff of 156, conducted 664 investigations, returned 78 indictments, 51 convictions, 21 civil settlements/judgement, and recovered $165,545,781 at a cost of $17,316,568. Louisiana’s MFCU has a staff of 54, conducted 492 investigations, returned 86 indictments, 75 convictions, 16 civil settlements/judgement, and recovered $40,374,660 at a cost of $5,710,826.
Medicaid has become increasingly burdensome on the State of Alabama. It is by far the most expensive program in Alabama’s state general fund budget.

Federal and state spending on Medicaid is skyrocketing. According to the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS), combined federal and state Medicaid spending has increased from $206.2 billion in 2000 to $529 billion projected for 2015. By 2023, total spending will reach $835 billion, of which the federal share will be $497.4 billion, and the state share will be $337.5 billion.

(Information on Medicaid spending was obtained from original reporting by the Heritage Foundation’s Nina Owarchenko.)

Brandon Moseley is a senior reporter with eight and a half years at Alabama Political Reporter. You can email him at [email protected] or follow him on Facebook. Brandon is a native of Moody, Alabama, a graduate of Auburn University, and a seventh generation Alabamian.

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Governor announces $356,000 in grants to community agencies to address poverty

Eddie Burkhalter

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(STOCK PHOTO)

Gov. Kay Ivey on Friday announced the award of $356,250 to 20 community action agencies statewide for programs aimed at reducing poverty. 

The Community Action Association of Alabama is to use the funds to support programs by the local agencies which help low-income families, according to a press release from Ivey’s office. 

“Our state’s community action agencies provide vital services to low-income residents who are working to establish or regain their footing to be successful,” Ivey said in a statement. “I commend the work these agencies do to further the goal of reducing and eliminating poverty by helping families build brighter futures.”

The 20 agencies to receive the federal community service block grants offer educational and assistance programs, including job training and education opportunities, access to better nutrition and help with financial management and credit counseling, according to the release. 

The funds are administered by the Alabama Department of Economic and Community Affairs and were appropriated by the state Legislature.  

“Gov. Ivey and ADECA fully support the assistance programs offered by these agencies because we have seen how they can serve as a jumpstart for life-changing success for Alabama families,” said ADECA Director Kenneth Boswell in a statement. “ADECA is pleased to continue our partnership with the Community Action Association by supporting the many valuable programs offered by the state’s community action agencies.”

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Hindu temple planned for vacant theater in Hoover

Micah Danney

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The vacant AMC theater off Lorna Road in Hoover, Alabama. (IMAGE VIA GOOGLE)

A local Hindu organization purchased a 38-square-foot former theater in the Birmingham suburb of Hoover and plans to convert it into a sanctuary and educational space to serve the area’s growing Hindu community.

Hindus make up less than 1 percent of Alabama’s population, and while an accurate count of adherents in the state is hard to come by, the number of Hindus in the U.S. has more than doubled over the last decade. 

Rajan Zed, a prominent Hindu cleric based in Reno, Nevada, issued a statement claiming that there is an increasing population of Hindus in Alabama that will require new temples, or mandirs, to “help the community to pass on Hindu spirituality, concepts and traditions to coming generations amidst so many distractions in the consumerist society.” 

Zed urged Hoover’s mayor and city council to unanimously approve the temple plans, “thus expressing warm welcome to the caring Hindu community” that he said is known for its charity and community development.

BAPS Birmingham is the group that owns the theater property. It operates a temple in North Birmingham that is currently closed due the pandemic. It proposed the plans for its second temple, which include a large worship space and 14 classrooms, to the Hoover Planning and Zoning Commission, which voted on Monday to recommend them for approval by the city council.

Mayor Frank Brocato said that he doesn’t anticipate anything preventing that approval. 

Before it closed, the BAPS Shri Swaminarayan temple hosted weekly assemblies and offered classes to teach children Gujarati, an Indian language distinct from Hindi but similar.

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There is another Hindu temple near Hoover not affiliated with BAPS, in neighboring Pelham. 

BAPS, which stands for Bochasanwasi Shri Akshar Purushottam Swaminarayan Sanstha, is a Hindu denomination established in 1907 with more than 1 million followers. It operates charities and learning centers worldwide and requires five lifetime vows from its followers: no alcohol, no addictions, no adultery, no meat and no impurity of body or mind.

The population of Hindus in the U.S. increased from 1.2 million in 2007 to 2.23 million in 2014, according to the Pew Research Center. Zed estimated that the number is around 3 million now. It is projected to reach 4.78 million in 2050, or 1.2 percent of the U.S. population.

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Prisoners quarantined at formerly closed prison kept in unconstitutional conditions, groups say

Conditions are so bad that inmates have been forced to urinate and defacate on themselves because restrooms are not accessible, the complaint alleges.

Eddie Burkhalter

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The male intake area at an ADOC facility. (VIA ADOC)

The Alabama Department of Corrections is violating the constitutional rights of inmates being quarantined in deplorable conditions in the previously decommissioned Draper prison, several civil rights groups wrote in a letter to the state’s prison commissioner.

The ACLU of Alabama, the Southern Center for Human Rights, Alabama Appleseed and other groups in a letter to Alabama Department of Corrections Commissioner Jeff Dunn on Thursday detail those conditions, which include no indoor toilets or running water, repeated power outages, deprivation of regular showers and the requirement of incarcerated men to urinate in “styrofoam cups and plastic water” bottles.

“These conditions fail to meet the most basic constitutional standards and present a substantial risk of serious harm to people already suffering from a potentially fatal disease,” the letter reads. “We therefore request that you immediately cease using Draper to house and/or quarantine COVID-19 patients, and instead house them in medically appropriate settings in accordance with Eighth Amendment standards.”

The groups note that Draper was closed after the U.S. Department of Justice, during its investigation of violence in Alabama prisons, noted Draper as exceptionally “dangerous and unsanitary” with “open sewage” near the entrance, rat and maggot infestations and “standing sewage water on the floors.”

In October 2017, the Justice Department informed ADOC of the department’s shock at the state of the facility and a month later ADOC’s engineer concluded that Draper was “no longer suitable to house inmates, or to be used as a correctional facility,” the letter states.

ADOC reopened a portion of Draper earlier this year to house incoming inmates from county jails being quarantined amid the COVID-19 pandemic, but the civil rights groups note in the letter that ADOC failed to indicate plans to also use a classroom without bathrooms, running water or adequate medical care at Draper to house COVID-19 patients from other state prisons.

The groups allege in the letter that approximately 15 cots are located in the approximately 500 square feet former classroom, where at any given time between 5 and 15 inmates are being kept. The only restroom facilities the men can use are portable bathrooms outside, and the men have to “bang on the classroom windows to get officers’ attention.”

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“Though officers sometimes escort the men when asked, they decline at other times and fail to maintain a schedule; thus, the men do not have access to bathroom facilities when needed,” the letter reads, adding that the men aren’t allowed to use the outdoor restrooms between 10 p.m. and 6 a.m.

“We have further reason to believe that one man was permitted to use the bathroom only three times during a 13-day quarantine. Another man was not taken to the bathroom until his third day at Draper, while another was forced to urinate on himself on multiple occasions after being denied bathroom access,” according to the letter. “One man suffering from diarrhea was forced to wait hours to use the restroom to defecate. Many others could only relieve themselves into styrofoam cups, plastic bottles, portable urinal containers, or trash cans.”

“They had to hold onto urine-filled bottles for hours at a time until they were allowed to leave the classroom to empty them. It is also our understanding that some men held in these conditions did not receive bottles at all; correctional officers simply told these men that they were ‘out of luck,’” the letter continues.

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The letter also details instances of alleged inadequate medical care, including a man who was sent to a local hospital with heart attack symptoms after not receiving his heart medication for several days.

The groups are also unaware of any Inmates leaving Draper who were tested for COVID-19 before being returned to Elmore and Staton prisons, the letter also states.

“We also have reason to believe that many of the symptomatic men at Staton and Elmore have not reported their symptoms to prison staff for fear of being held at Draper in the deplorable conditions described above,” the letter continues.

APR has learned from several sources in recent weeks, who asked not to be identified because they have loved ones in Alabama prisons and are fearful of retributions for speaking out, that many inmates who have symptoms of COVID-19 aren’t reporting those symptoms to prison staff for fear of being quarantined. Those family members are concerned that the disease is spreading much more broadly in Alabama prisons than is known as a result, putting their loved ones at greater risk of contracting the deadly disease.

Many of the concerns expressed in the letter were first reported by AL.com reported on Sept. 13, which found that access to medical care in Draper is limited and the conditions unsanitary.

In a response to AL.com’s questions for that article, an ADOC spokeswoman wrote that inmates at Draper have access to “medical and mental health care, telephones, law library, mail services, and showers.”

“Please remember — Inmates remanded to our custody have been convicted of a crime and handed a sentence to serve time as determined by a court. The unfortunate reality is that he or she, as a result of the crime committed and subsequent conviction, loses his or her freedoms,” ADOC said in the responses.

“This response is unacceptable as a matter of principle, and inadequate as a matter of law,” the letter from the civil rights group states.

“As ADOC knows, the fact of a criminal conviction does not strip incarcerated people of their rights under the Eighth Amendment, nor does it relieve ADOC of its constitutional obligations to the people in its custody, which are to provide them with ‘humane conditions of confinement,’ ‘adequate food, clothing, shelter, and medical care,’ and ‘reasonable safety,’” the letter continues.

On Sept. 16, ADOC reported that there have been 403 confirmed COVID-19 cases among inmates, 21 deaths of inmates after testing positive for COVID-19, and 375 cases among prison staff. Two prison workers have died from COVID-19, ADOC previously said.

As of Sept. 14, there had been 1,954 inmate tests for coronavirus, out of the approximately 22,000 state inmates, according to ADOC.

ADOC on Sept. 16 said that on Thursday the department was to begin rolling out a plan to provide free COVID-19 tests to ADOC staff and contracted healthcare staff using fixed and mobile testing sites.

“In addition, we will test all inmates in facilities that house large numbers of inmates with high risk factors as an enhancement to our current testing protocols,” ADOC said in a press release.

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Study: Those with COVID twice as likely to have dined in restaurants

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes. 

Eddie Burkhalter

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(STOCK PHOTO)

A recent study by the Centers for Disease Control and Prevention found that adults who tested positive for COVID-19 were twice as likely to have eaten in restaurants, which builds upon known factors about how the disease is transmitted, experts say, but the study has limitations.

The study surveyed 314 adults in 10 states and found that those who tested positive for COVID-19 were twice as likely to have eaten at restaurants within the previous 14 days. Researchers found that there was no significant difference between those who tested both positive and negative and who said they had gone to gyms, coffee shops, used public transportation or had family gatherings.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes.

Dr. Bertha Hidalgo, an epidemiologist and associate professor at UAB’s School of Public Health, told APR on Wednesday that the study lends evidence to what the medical community knows are potential risks for contracting COVID-19, which include being indoors and unmasked, but there are nuances to each of those activities that can either increase or decrease that risk.

The study did not differentiate between indoor and outdoor dining, and infectious disease experts say being outdoors decreases the risk of contracting COVID-19.

“It’s also hard to know what policies are in place where these people were recruited from for this study,” Hidalgo said. “Whether they’re required to be masked or if there’s a decreased capacity in a restaurant.”

Monica Aswani, assistant professor at UAB’s School of Health Professions, said she would be cautious about interpreting the study through a causal lens.

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“People who are willing to dine in restaurants are also likely to engage in other risky behaviors, such as not wearing masks. Since this is a survey, there is not enough evidence to suggest that the source of exposure was restaurants without contact tracing to supplement it,” Aswani said. “Likewise, respondents may have misreported their behaviors, given the sensitive nature of the questions. The authors note this as a limitation and highlight how participants were aware of their Covid-19 test results, which may have influenced how they responded.”

Aswani also noted that the questions about dining did not differentiate between indoor versus outdoor seating, “which represent different levels of risk to exposure.”

“Participants who visited a restaurant on at least one occasion, regardless of the frequency, are also considered similar. Consequently, in the two weeks before they felt ill, someone who dined on a restaurant patio once and someone who ate indoors at five different restaurants are indistinguishable in their data,” Aswani said.

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Hidalgo said that while there are clear limitations to the CDC’s study, the findings do back up what the medical community knows about the transmission of the disease.

“I would very much look at this from the big picture perspective, and say we know that indoor activities are an increased risk for COVID-19. This study lends evidence to that,” Hidalgo said.

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