Whistleblower Alleged that the Adult Day Care Provider Overbilled Georgia Medicaid for Developmentally Disabled Adults
Bracker & Marcus LLC is pleased to announce a $150,000 False Claims Act settlement with Comfort Community Center, LLC, and its owner, Emmanuel Wohiren. The settlement resolves allegations filed by their client, whistleblower Sharon “Shay” Engram.
Comfort Community Center is a for-profit provider of services to adults with behavioral and developmental disabilities, mental health diagnoses, and traumatic brain injuries. Ms. Engram served as Comfort Community Center’s Program Director for approximately six months beginning in 2013.
Developmental Disabilities and the Medicaid Waiver Program
A developmental disability is defined by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) as a cognitive and/or physical impairment that continues indefinitely. It manifests before the age of 22 and results in limitation in at least three of the areas of self-care, receptive/expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency.
Nationally, one out of every six families is affected by some type of developmental disability, such as autism, cerebral palsy, Down’s syndrome, epilepsy, or neurological impairment. There are approximately 98,000 people in Georgia living with a developmental disability.
The financial impact on these families is staggering; it costs two to three times more to care for a loved one with a disability compared to someone without a disability.
Compounding the problem, 53% of Georgia households with a disabled member have annual incomes under $30,000, and 29% have annual family incomes under $15,000. About 28% of children with disabilities live in poverty.
Once they age out of the educational system, developmentally disabled adults often require further support. Medicaid Waiver programs, run in Georgia by the DBHDD, assist with funding. Facilities like Comfort Community Center accept these waivers for payment and in turn provides a day training program for developmentally disabled adults.
The centers are staffed by Direct Support Technicians who follow an Individual Support Plan that is created for each client. Certain clients with severe disabilities require one-on-one or two-on-one support. To fund this level of care, Medicaid pays a higher “Exceptional Rate.”
The False Claims Act Suit
Relator Shay Engram first came to Comfort Community Center in January 2013. Her arrival came after several months of consulting with its management about ongoing issues, agreeing to accept the titles of Program Director, Behavioral Specialist, and Developmental Disability Professional.
As a nationally certified Non-Violent Crisis Intervention Trainer, a Registered Behavior Technician, and a Qualified Developmental Disability Professional of more than twenty-five years with a master’s degree in Psychology, Relator Engram was the perfect person for the position. In fact, Relator Engram has devoted her professional life to helping others in situations ranging from abuse and neglect to physical and developmental disabilities, as well as trying to improve the lives of those with mental health and behavior disorders.
In her suit, Ms. Engram alleged that things soured very quickly. She states that when she started at Comfort Community Center, there was an overall lack of adequate staffing. Even standard 10-to-1 ratios were not being followed.
She further alleged that Exceptional Rate clients were being shuffled into groups and Individual Support Plans were not being created, maintained, or followed. When she objected, her suit alleged retaliation that damaged her reputation and career, denying the vulnerable citizens of Georgia one of their staunchest advocates.
After reporting her concerns internally and to the state, Ms. Engram retained Bracker & Marcus LLC to file a qui tam lawsuit.
“I truly appreciate all of the noble caregivers and energetic experts that came forward to contribute to this case to support the most vulnerable (Developmentally Disabled) population,” stated Ms. Engram. “It is always right to do the right thing!”
Whistleblowers Protect Our Most Fragile Citizens
On a personal note, I could not be prouder to represent Shay Engram. The look on her face when I told her that I believed her and that we could do something about her situation will always be with me.
In addition to helping a champion of the disabled and returning her to her chosen arena, this case showcases why I believe that the False Claims Act is about more than money. With this case, we have helped protect some of our most fragile citizens. The case is not large in terms of dollars, but its impact is immeasurable.
The case is captioned United States ex rel. Engram v. Comfort Community Center, LLC et al., 1:15-cv-3737 (N.D. Ga.).