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MADISON — Attorney General J.B. Van Hollen announced that six more people were convicted of crimes in a Medicaid fraud scheme related to the submission of false claims for durable medical equipment.
Those convicted today were:
The six appeared in Milwaukee County Circuit Court and were convicted of a total of 18 felony counts of Medicaid fraud. The Honorable Dennis R. Cimpl, Branch 19, ordered presentence investigation reports and scheduled sentencing for June 7 and 28, 2012.
Previously convicted on March 15 in conjunction with the same operation and scheduled for sentencing on May 23 is:
According to the Department of Justice's criminal complaints, the seven defendants were engaged in a scheme to defraud the Wisconsin Medicaid program by the submitting of claims for payment for the provision of durable medical equipment (DME) used for orthotic purposes. Orthotics is a branch of medicine that deals with the use of specialized mechanical devices to support weakened joints or limbs.
Each of the seven had submitted applications to Wisconsin Medicaid to become durable medical equipment providers. Each properly completed the application process and was granted a provider number and authorization to bill Medicaid for services provided.
The claims that followed were primarily for halo cervical devices, tension scoliosis devices, and KAFO devices used to support the knee-ankle-foot. That equipment typically requires specialized medical treatment for installation and use so there should have been complementary claims from hospitals or physicians for the equipment claims. No complementary claims were filed, and further investigation revealed that the recipients for whom the devices were allegedly provided did not know the providers, nor did they have need for such orthotic devices.
The total amount claimed through such billings was $1,253,816.73, but the Bureau of Public Integrity at the Wisconsin Department of Health Services was able to identify and intercept $199,747.03 before it was paid out. The Medicaid Fraud Control and Elder Abuse Unit of the Wisconsin Department of Justice conducted the investigation that led to the filing of the seven criminal complaints.
This case is being prosecuted by Assistant Attorney General Thomas Storm.