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Ben Jones
Ben Jones, Lawyer
Category: Fraud Examiner
Satisfied Customers: 1814
Experience:  Lawyer with fraud examination experience
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I work at a small nonprofit and think the Administrative Director

Customer Question

I work at a small nonprofit and think the Administrative Director alone or in conjunction with the Executive Director may be diverting Medicaid payments to a separate unknown bank account. If Medicaid is not billed within 3 months of service, they will not pay. For the past 9 months, our Administrative Director has gotten further and further behind in billing, so that we now are $100,000 behind in billing. Much of that billing has gone past the 3 month period and is "uncollectable."
Our Administrative Director says she is too busy otherwise to keep up with all the billing, but becomes very stubborn if anyone tries to get in and help her. She has even refused the Board President. The Executive Director gets all anxious and upset, strongly protects our Administrative Director, acts like she is trying to help, but in reality has done absolutely nothing, which is odd, because she spent the last ten years building up a reserve of $300,000, which is being drained in a matter of months. Our ED began talking about deliberately closing the agency as soon as these problems began, which seemed very premature and negative at the time, but now I wonder if she was planing ahead to divert all the reserves and shut down the agency because of the billing issues.
The audit shows no problems, but would not show supposedly uncollected bills secretly being collected and deposited elsewhere. I have repeatedly encouraged my Executive Director to get a rendering from Medicaid, which would show what bills the have actually paid us against what bills our Administrative Director says have been paid. Our Executive Director has cried and accused me of being too suspicious, has made light of it several times, and said she would take care of it several times and never did. Only our Administrative Director has the username and password ***** check this.
Now, I'm worried about both women. Our very small board are all good friends with the Executive Director and responded to one employee informant by wanting to fire that employee. I caught my Executive Director coming out of my office twice yesterday when I was coming back from another part of the building. She had no business in my office, no explanation, such as "Oh there you are!" and just distracted me from asking me about by barraging me with a bunch of unrelated questions.
Am I overreacting? What do I do? Who do I talk to?
Submitted: 8 months ago.
Category: Fraud Examiner
Expert:  TheFraudExpert replied 8 months ago.
Hello, my name is ***** ***** I will be the expert assisting you today. I am so very sorry to hear about this situation. I have a couple of questions for you:1) Exactly what type of non-profit business is it?2) Does this non-profit receive government funding or grant funding for its operations?3) Do you feel that your job is currently in jeopardy?4) What is the end goal that you would like to achieve in this situation?
Customer: replied 8 months ago.
1) Mental health counseling.
2) Half of the agency's income is from therapist's fees collected mostly through Medicaid, but some through self-pay and other insurance billing. All agency therapists are contract and not salaried employees. The other half of the income comes from fundraising: 2/3's from private grants & foundation & 1/3 from individual donations, corporate sponsorships & events. No government grants.
3). There are only 5 full time administrative staff. I am Develpment Director and have been at the agency since last July. I handle marketing, community outreach, 3 major fundraising events, annual fund, volunteers, social media, website, email campaigns, etc. The ED handles the grants.My job shouldn't be in danger, since I have exceeded all my financial goals and have made sure our Board knows this as well. However, our ED has been there for 11 years and got her job through a coup as a board member ousting the ED at the time. Since then, there has been enormous turnover at the agency, including among board members. As the only person at the agency for more than 5 years, the ED is in a position to control agency history. I think she likes me, but also tries to make sure no one else, including me, thinks too highly of me. She has even gone so far as to report wrong numbers to our board to make my performance look mediocre instead of high and vice versa concerning her own numbers. For my numbers, I've politely, but publicly corrected her each time. She is very wary of people she considers strong and generally tries to run them off, which she hasn't done to me yet. However, I have been pushing her pretty hard to take charge and fix the billing situation and have also been pushing her to check out the fraud, neither with any luck. Her being in my office twice for no apparent reason has scared me. I am also looking for another job, but am 65, and job hunting is more difficult at that age.
4). I think our agency is a wonderful nonprofit with an important mission and niche in our community. I hate to see it close because our ED is too lazy or dishonest to fix the billing. I want to make sure no fraud is taking place and if it is, fix it as quickly as possible in hopes of recovering at least some of the money. Privately, I feel we also need a new ED, one who will put effort & energy into the agency. That is all our agency needs to flourish. Instead, we have an ED who appears to be deliberately leading our agency toward closure for a reason I don't understand and may even be fleecing our agency. Finally, I want to keep my job only if these things happen. However, I especially don't want to get fired before I find a new job. I don't have a whistleblower personality.Thank you!
Expert:  TheFraudExpert replied 8 months ago.
Sorry for the delay in responding, but thank you for all of the detailed information. Regarding the potential fraud: 1) most non profit organizations have a clearly defined internal process for employees to follow when reporting potential problems such as the billing issue within the organization. Does your non profit have such a process or policy? 2) Additionally, most non profits have a whistleblower protection or anti-retaliation policy. Having a policy in place helps your organization protect itself from the risk of violating state and federal laws that protect whistleblowers, and can help ensure that if there is a problem it will be investigated and fixed. Does your non profit have a whistleblower protection policy?