Owner of Child Autism Services Agency Pleads Guilty to Health Care Fraud | USAO-CT

Leonard C Boyle, Acting United States Attorney for the District of Connecticut, announced that NICOLE M. BALKAS, 31, of Bridgeport, waived her right to be indicted and pleaded guilty today before U.S. District Judge Jeffrey A. Meyer in New Haven to one count of health care fraud.

According to court documents and statements made in court, Balkas owned and operated Helping Hands Academy, LLC, in Bridgeport, which provided applied behavior analysis services to children diagnosed with Autism Spectrum Disorder (ASD).   Helping Hands Academy enrolled as a participating provider in the Connecticut Medicaid Program (“Medicaid”) in approximately September 2018.

From December 2018 to October 2020, Balkas submitted and caused to be submitted fraudulent claims to Medicaid for applied behavior analysis services that were purportedly provided to Medicaid clients.  Balkas submitted claims for dates of service when no applied behavior analysis services of any kind had been provided to the Medicaid clients identified in the claims, and she inflated the number of hours for certain claims even when applied behavior analysis had been provided to the Medicaid clients identified in the claims.

In addition, in September and October 2020, Balkas submitted, and was subsequently paid for, Medicaid claims in which she falsely claimed that a former Helping Hands Academy provider, who was a Board Certified Behavior Analyst (“Individual 1”), performed Medicaid-approved services when, in fact, Individual 1 was not employed by Helping Hands Academy on those dates of service, provided no such services to the clients identified on the claims, and was not aware that Helping Hands Academy or Balkas was billing Medicaid using Individual 1’s name and performing provider number.  Individual 1 had resigned from Helping Hands Academy in July 2019.

In August 2020, the Connecticut Department of Social Services (DSS), which administers the Medicaid program in Connecticut, terminated Helping Hands Academy as a provider.  In an effort to rescind the termination and to receive payment for previously submitted claims, Balkas made several false statements and submitted an altered document to DSS.

Medicaid suffered a loss of $551,311.85 as a result of Balkas’ conduct.

Judge Meyer scheduled sentencing for July 21, 2021, at which time Balkas faces a maximum term of imprisonment of 10 years.  Balkas also will be ordered to make full restitution.

Balkas is released on a $50,000 bond pending sentencing.

This investigation is being conducted by the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and the Federal Bureau of Investigation.

Acting U.S. Attorney Boyle acknowledged the valuable cooperation of the Connecticut Department of Social Services in the investigation.

This case is being prosecuted by Assistant U.S. Attorney David T. Huang.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.

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Author: Editor
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