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Special Needs D.C. Charter School Suspected of Medicaid Fraud

By: Allan Siegel

The D.C. Charter School Options has recently come under major scrutiny for possible Medicaid fraud in its busing program. Options is a school that works specifically with special needs children in the District. It is designed to help give these children the therapy, educational environment, and medical services that they need. Unlike the rest of the D.C. Public School System, Options' busing program is run by its own for-profit subsidiary, Exceptional Education Services (EES). A grand jury investigation is underway to determine if Options and ESS intentionally defrauded Medicaid through reimbursements. The glaring signs of possible fraud are the sharp increase of intensive care claims and gift card incentives given to children who rode ESS buses. In the middle of the 2012-2013 school year Options reported a 42% increase of special needs students with intensive needs. This number stands in stark contrast to the average 15% annual student enrollment increase. Options also claimed it provided this influx of intensive needs students riding its EES School Busbuses with therapy during transportation services. A therapeutic service must be provided at some point during the school day for the school to claim reimbursement for transportation services. The therapy provided during transportation consisted of an Options employee talking with the students to help start their day off well. These employees did not have the professional licenses required in order to properly apply for Medicaid reimbursement. A proper reimbursement would be for services provided by social workers, counselors, psychiatrists, or therapists.

The gift card incentive program also appears to be suspicious. Options claims that the incentive program was part of an anti-truancy program. However, students were only given the cards when they rode ESS buses not for showing up to school. Each week the children who rode the ESS buses they were given a $50 gift card. The ESS bus ridership increase allowed Options to increase its busing budget from $450,000 to $750,000. Options also hoped ESS could provide Medicaid billing services for other D.C. schools , which would produce "additional income for Options." It is also clear from a Washington Post investigation that Options employees were planning to use additional income for employee bonuses. Bonuses which it planned to structure according to the amount of Medicaid reimbursements received through EES. What it boils down to is money, the bigger the reimbursement the bigger the bonuses. Hopefully the grand jury investigation will help put an end to any possible Medicaid fraud, and the children of Options can be given the proper services, attention, and dedication that they deserve.