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Milwaukee Woman Sentenced for Medicaid Fraud

 

MADISON — Attorney General J.B. Van Hollen announced today that Erica Danley of Milwaukee was sentenced on convictions for Medicaid fraud related to the submission of fictitious claims for durable medical equipment.  Danley was the last to be sentenced of seven defendants who have been convicted in regard the fraudulent scheme.

 

On July 19, 2012, Milwaukee Circuit Court Judge Dennis R. Cimpl imposed sentence on three counts of medical assistance fraud.  On the first count, he ordered Danley to serve one year in the House of Corrections.  On the second and third counts, he ordered a total of six years imprisonment, imposed and stayed, and placed Danley on four years probation, all consecutive to the first count.  Cimpl ordered restitution to Wisconsin Medicaid in the amount of $114,856.12, as well as multiple rehabilitative and educational conditions as part of the sentence.

 

According to the criminal complaint, the defendant participated in the scheme to submit payment claims to Wisconsin Medicaid for the provision of durable medical equipment (DME) used for orthotic purposes.  Medicaid is a healthcare program for the needy and disabled jointly funded by the state and federal governments.  Orthotics is a branch of medicine that deals with the use of specialized mechanical devices to support weakened joints or limbs. 

 

Danley submitted an application to become a DME provider, obtained a provider number and authorization to bill for DME provided.  Claims followed 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, but no such complementary claims were filed. 

 

Further investigation revealed that the Medicaid recipients for whom the devices were allegedly provided did not know Danley or have need for such orthotic devices. 

 

The Medicaid Fraud Control and Elder Abuse Unit of the Wisconsin Department of Justice conducted the investigation that led to the conviction of the seven defendants.  The case was prosecuted by Assistant Attorney General Thomas Storm.  Amy Severt of the Department of Justice Office of Crime Victim Services provided victim assistance.