Gainesville man accused of defrauding $150K from Medicaid

A Gainesville man pleaded guilty Tuesday to defrauding state Medicaid of nearly $150,000.

Prosecutors said David Brannon billed Georgia Medicaid for services from his Brannon Pediatrics that weren’t provided by caregivers working there.

Brannon’s company is enrolled in Georgia Medicaid to offer therapeutic services to children. He was in charge of billing and submitting claims for Medicaid reimbursements, prosecutors said.

According to state officials, a therapist Brannon formerly employed reported that he had submitted Medicaid claims under her assigned provider code for services she didn’t provide.

The therapist also told prosecutors that Brannon continued to submit claims under her code even after she left the company, and he “upcoded,” or billed for services with higher reimbursement rates than the services rendered, prosecutors said.

State investigators found similar fraudulent activity in other therapists’ records, prosecutors said.

During a July 2011 audit, prosecutors said Brannon admitted billing Medicaid without knowing whether the services had been rendered, not advising Medicaid when services billed had not been rendered, and submitting “upcoded” billing reflecting higher level procedures although lower-coded procedures were performed , documented and submitted by the therapists.

Brannon was sentenced under the First Offender Act to five years of probation, a $2,000 fine and 100 hours of community service, and he has paid the full restitution of $146,367, authorities said.