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MADISON — Attorney General J.B. Van Hollen announced today that Ericka Thomas of Milwaukee was sentenced on convictions for Medicaid fraud related to the submission of fictitious claims for durable medical equipment. Thomas was the second to be sentenced of seven defendants who were convicted in regard the fraudulent scheme.
On June 7, 2012, Milwaukee Circuit Court Judge Dennis R. Cimpl imposed sentence on four counts of medical assistance fraud for a total of twelve years imprisonment, comprising four years initial confinement and eight years extended supervision. Cimpl ordered restitution to Wisconsin Medicaid in the amount of $356,366.33, as well as multiple rehabilitative and educational conditions as part of the sentence.
According to the criminal complaint, the defendant submitted 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.
Thomas 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 Thomas nor have need for such orthotic devices. Thomas submitted another $42,454.03 in claims that the Wisconsin Department of Health Services intercepted after it determined the claims were fictitious and before money was paid out.
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.