Milwaukee Woman Sentenced for Medicaid Fraud

MADISON — Attorney General J.B. Van Hollen announced today that a Milwaukee woman has appeared for sentencing on a conviction for Medicaid fraud related to the submission of fictitious claims for durable medical equipment. Donnis Carrington was convicted of medical assistance fraud on March 16, 2012, with two counts of identity theft dismissed and read-in for consideration at sentencing.

On May 23, 2012, Milwaukee Circuit Court Judge Dennis R. Cimpl imposed and stayed a sentence of three and half years imprisonment, comprising one and a half years of initial confinement and two years on extended supervision. Carrington then was placed on probation with conditions to include six months in the House of Corrections, no possession of dangerous weapons, absolute sobriety, and various other educational and rehabilitative components.

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.

Carrington submitted an application to become a DME provider, obtained a provider number and authorization to bill for DME provided. The claims that followed were 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 Carrington nor did they have need for such orthotic devices. The fraudulent claims totaled $32,250, but the Department of Health Services intercepted payment after it determined the claims were fictitious and before any 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.