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Investigation: JABA Enterprises employees billed for unworked hours, 20% of claims rejected

Posted at 4:33 PM, Feb 26, 2018
and last updated 2018-10-24 12:31:59-04

The state Legislative Auditor’s investigation of embattled JABA Enterprises has been released.

The auditors found that employees had recorded nearly 800 hours they didn’t work; that JABA submitted more than $1 million in bills directly to Medicaid instead of to the state as required; and that documentation for many long-time patients was inadequate or nonexistent. To read the entire audit, scroll down.

During a four-year period between January 2012 and June 2016, JABA submitted more than 275,000 claims to the state for reimbursement under Medicaid, totaling more than $18 million. Almost 20 percent of those claims, totaling about $2.6 million, were rejected. That is a high rate of rejection, and that is what triggered the audit, the auditors wrote.

JABA is a home health agency owned and operated by Jeanerette Mayor Aprill Foulcard and her family. In addition to Foulcard, the agents and/or officers of the organization are Berwick Francis, Jacqueline Francis and Antigone Anthony.

Berwick Francis is Foulcard’s brother, and an Iberia Parish Council Member. Jacqueline Francis is their mother. Anthony, of Broussard, is the sister of Aprill and Berwick, and the daughter of Jacqueline. Anthony currently is facing a 24-count bill of information in state court which accuses her of illegally altering prescriptions to obtain hydrocodone. Her trial is set for April, and until then she is out on $60,000 bond. To read that document, scroll down. It’s below the audit. She’s also facing charges of forgery and drug possession in Iberia Parish. That case also is set for trial in April.

The state Department of Health is currently moving on three fronts to shut down JABA: The department issued a letter to JABA, excluding them from participation in the state’s Medicaid program; the department is terminating its agreement with JABA; and the state will not renew JABA’s license when it comes up for renewal next month. To read that story, click here.

Last summer, state Medicaid Fraud investigators arrested seven JABA employees. To read those stories, click here and here.

State officials are moving to take over all financial operations of Jeanerette from Foulcard. After she was unable to produce records to show how city funds were spent for three years in a row, the Legislative Auditor’s Fiscal Review committee voted to appoint an administrator who will oversee all operations of the city, including hiring, firing, spending, contracts and all aspects of the budget. To read that story, click here.

In Monday’s release, investigators listed several shortcomings in JABA operations.

Among them:

Eight employees recorded more than 750 hours they didn’t work; auditors found alternate employment records, incarceration records and drivers’ license records that showed they were somewhere else during the hours they claimed to have worked.

  • One man was in jail when he was supposedly taking care of his brother. his mother told auditors the man’s girlfriend filled out his timesheets, and that she was taking care of the brother. JABA’s response was that the man didn’t tell them he was in jail.
  • Auditors visited one family to speak to an employee, who wasn’t there. the family called the employee, who showed up to speak to auditors at 11:15 a.m. She submitted a timesheet that showed she started work at that home at 9:00 a.m. that day – even though the auditors were there and knew she didn’t show up until 11:15 a.m. JABA’s response was that the worker was grocery shopping for the patient that morning.
  • Auditors even compared records of the state Department of Motor Vehicles to check the dates and times when driver’s licenses were issued to employees and compared those dates to time sheets – and they found discrepancies.

By submitting these timesheets, employees may have violated state law, and by billing medicaid for the work, JABA may have  violated its agreements with the state, auditors wrote.

During a four-year period, JABA submitted more than $1.3 million without sending those bills to the state for review and approval first. JABA’s response was, they weren’t reimbursed for services rendered. 

By bypassing the state to submit bills to Medicaid directly, JABA may have violated its agreements with the state, auditors wrote.

The clients who had the highest-dollar amount of bills in the four-year period lacked adequate and accurate documentation.

In one program of care funded by Medicaid, family members can provide services to patients, but only if they don’t live with the patient.

  • Auditors checked one employee’s address on the person’s driver’s license and it matched that of the patient. When they looked at JABA’s records, the employee’s proof of address was a photocopy which had been altered to change the address.
  • A JABA employee who was paid more than $180,000 over a four-year period was found to have been working for a municipality while she was supposed to be working for JABA. The records of the municipality also show she lived at the same address as the patient – but JABA’s records showed another address. JABA
  • JABA’s response was, most of the documentation was adequate. JABA also pushed blame onto the employees, saying they trained employees on proper procedures.
  • A family member who was allegedly signing a JABA employee’s timesheets as his verification that his mother was receiving services was actually in jail at that time.
  • Service logs filled out by employees didn’t match daily notes.
  • Service logs filled out by employees claimed identical services for every day of an entire year.

JABA’s response was that employees were properly trained in proper procedures; they included a stack of forms they provide to employees and clients to fill out. The company also wrote that they believe there were “misunderstandings” between clients and the auditors who interviewed them regarding services provided.

By failing to properly document charges, auditors, wrote, JABA may have been improperly reimbursed.

JABA is not in good standing with other state agencies, and has been cited for failure to file reports or remit amounts owed. Being in good standing with state agencies is required by JABA’s state agreements.

JABA’s response was that they would update their filings with all state agencies. In one case, JABA said that they weren’t able to update the filings until now because their difficulty with Medicaid reimbursements had caused a cash flow problem.

Here’s the full audit: