Agency Owner Admits Guilty to Health Care Fraud Charges

Agency Owner Admits Guilty to Health Care Fraud Charges

The District of Connecticut Acting United States Attorney Leonard C Boyle reported that Nicole M. Balkas, age 31, from Bridgeport, renounced her right to be charged and admitted guilty on 28th April 2021 before Jeffrey A. Meyer, U.S. District Judge in New Haven to one health care fraud count.

Pursuant to court documents and attestations made in court, Nicole Balkas owned and ran Helping Hands Academy, LLC, based in Bridgeport, which offered applied behavior analysis services to kids diagnosed with ASD (Autism Spectrum Disorder).   Helping Hands Academy registered as a Connecticut Medicaid Program contributing provider around Sept. 2018.

Between Dec. 2018 and Oct. 2020, Nicole Balkas submitted and triggered to be submitted false claims to the Connecticut Medicaid Program for applied behavior analysis services that were allegedly offered to Medicaid beneficiaries.  Nicole Balkas submitted submissions for service dates when no applied behavior analysis services of any type had been offered to the Medicaid recipients identified in the submissions, and she overstated the number of hours for specific claims even after applied behavior analysis had been offered to the Medicaid recipients identified in the submissions.

Besides, in Sept. and Oct. 2020, Nicole Balkas submitted and was then reimbursed for Medicaid submissions in which she deceitfully claimed that an ex- Helping Hands Academy provider, formerly a Board Certified Behavior Analyst, identified in the charge as (“Individual 1”), carried-out Medicaid-permitted services when, actually, Individual 1 was not hired by Helping Hands Academy on those service dates, rendered no such services to the recipients identified on the submissions, and had no knowledge that Helping Hands Academy, or Nicole Balkas was charging the Connecticut Medicaid Program via Individual 1’s name and Medicaid provider number.  Individual 1 had demitted from Helping Hands Academy in Jul. 2019.

In Aug. 2020, the Connecticut Social Services Department, which runs the Connecticut Medicaid Program, excluded Helping Hands Academy as a Medicaid provider.  In an effort to overturn the exclusion and to obtain reimbursement for earlier submitted submissions, Nicole Balkas made numerous fake statements and submitted a forged document to the Connecticut Social Services Department.

Due to Nicole Balkas’s deceitful billing, the Connecticut Medicaid Program suffered a loss of 551,311.85 U.S. dollars.

Nicole Balkas will be sentenced on 21st July 2021 as set by Judge Meyer and faces a maximum imprisonment term of ten years.  Besides, Nicole Balkas will be directed to reimburse full restitution.

Nicole Balkas is released on a 50,000 U.S. dollar bond awaiting sentencing.

The HHS-OIG (U.S. Health & Human Services Department – Office of the Inspector General) and the FBI (Federal Bureau of Investigation) conducted the case’s investigations.

Acting United Attorney Boyle thanked the Connecticut Social Services Department for the valuable cooperation during the investigation.

The United States Assistant Attorney David T. Huang is handling this case’s prosecution.

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