A husband-and-wife physician duo exaggerated the number of urine samples they collected in order to overbill Indiana Medicaid by more than $1.1 million, according to a civil Medicaid fraud complaint filed today in U.S. District Court in the Northern District of Indiana.
Indiana Attorney General Curtis Hill and U.S. Attorney Thomas L. Kirsch II today announced the filing against former physicians Don J. Wagoner and Marilyn L. Wagoner. The complaint also applies to the following businesses: Wagoner Medical Center, L.L.C.; Wagoner Medical Center, P.C.; and Don J. Wagoner, M.D. and Marilyn L. Wagoner, M.D., P.C.
Working in the communities of Burlington and Kokomo, the Wagoners filed false claims from 2011 to 2013 in order to receive more money than they were entitled, according to the complaint. The couple billed Indiana Medicaid $171.27 per patient for collecting urine samples when Medicaid rules only allowed them to bill $20.83 per patient.
The Wagoners concealed their fraudulent activity by reporting they collected and analyzed nine or more urine samples from each patient when, in fact, they only had collected and analyzed one sample per patient, according to the complaint. The defendants followed this deceptive practice over the course of 6,400 separate claims.
The federal False Claims Act and the Indiana Medicaid False Claims Act allow the federal government and the State of Indiana to recover three times the amount of the false and fraudulent claims submitted to Indiana Medicaid — plus a civil penalty of $5,500 to $11,000 per false claim submitted. A small portion of recoveries under the federal False Claims Act (3 percent) is used to fund the cost of future health care fraud investigations and cases. Maximum possible recovery, then, would exceed $70 million.
“Working to recover taxpayer funds taken through fraud and other illegal means is part of our responsibility as stewards of the public trust,” said Attorney General Hill. “We appreciate the collaboration of our federal partners in this particular case, and we intend to remain vigilant going forward to make sure monies set aside to help society’s most vulnerable members are truly used for that purpose.”
This complaint against the Wagoners does not represent the first time the two former physicians have found themselves at odds with state authorities. In 2013, these same defendants permanently surrendered their licenses to prescribe drugs and to practice medicine following a state criminal investigation of their opioid-prescribing practices, which resulted in felony drug dealing convictions of defendant Don J. Wagoner.
“Although they no longer are endangering vulnerable Medicaid patients by practicing medicine, former physicians Don Wagoner and Marilyn Wagoner cannot be allowed to retain the fruits of their fraudulent Medicaid claims,” said U.S. Attorney Kirsch. “My office will continue to make it a priority to pursue investigations and cases to recover funds that were fraudulently received from the Medicare and Medicaid programs. The Justice Department’s Commercial Litigation Branch has given a high priority to civil prosecution of health care fraud, including Medicare and Medicaid fraud.”
The suit results from an investigation by the Indiana Medicaid Fraud Control Unit and the U.S. Attorney’s Office for the Northern District of Indiana.