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MADISON — Attorney General J.B. Van Hollen announced that George Woods, Jr., of Milwaukee was sentenced on convictions for Medicaid fraud related to the submission of claims for fictitious durable medical equipment. Woods was the tenth to be sentenced of eleven defendants convicted for the fraudulent scheme.
On August 25, 2014, Milwaukee Circuit Court Judge William Brash III imposed sentence on three counts of medical assistance fraud for a total of 12 years imprisonment, comprising five years initial confinement and seven years extended supervision. Brash ordered restitution to Wisconsin Medicaid in the amount of $257,376.58, as well as community service and multiple rehabilitative conditions, as parts 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 those with disabilities and financial need, 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.
Woods 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 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 for hospital or medical care services.
Further investigation found that the Medicaid recipients for whom the devices were allegedly provided did not know Woods nor have need for such orthotic devices. Woods also worked with others to file similar claims for fictitious equipment.
The case was investigated and prosecuted by the Medicaid Fraud and Elder Abuse Unit of the Wisconsin Department of Justice, and the Office of the Inspector General in the Wisconsin Department of Health Services.