Prosthetics Company in North Carolina Accused of Medicaid Fraud

A prosthetics provider based in North Carolina allegedly fraudulently billed Medicaid for more than $12 million in unnecessary medical equipment costs and other charges that should never have been sent to the federal government for reimbursement, according to federal prosecutors.

Medicaid Fraud Includes Multiple Claims of Illegal Activity

The provider allegedly billed Medicaid for durable medical equipment that was never purchased or given to patients. Furthermore, the claims from state and federal governments against the prosthetics company allege that these overpayments were due to claims for support products that were never needed. Furthermore, many of these devices were never even given to the patients.

A court-appointed receiver took over for the company temporarily while there was a legal battle over who rightfully owned the company. The court-appointed receiver identified the alleged Medicaid fraud and reported it to the government after working for the company for a short period of time.

More than $9 million in Medicaid payments is alleged in the Medicaid fraud lawsuit including unnecessary purchases of bone growth stimulators, powered air flotation beds, foot, ankle and knee orthotics, power wheelchair accessories, and calf stimulating devices.

As in this and other Medicaid fraud cases, the insight from a whistleblower was the first way the government identified the scheme. Whistleblowers are often employees working for a company who become aware of inside information related to fraud and illegal activity.

Most Common Types of Medicaid Fraud

There are many different types of federal Medicaid fraud, including billing for services never rendered, billing the government for services not needed or for patients who did not exist, or billing more than one for the same product or service.

The receiver statements included in the Medicaid fraud lawsuit were allegedly false and fictitious. Furthermore, Medicaid paid $900 for breast prosthetics and mastectomy bras for a patient who did not have cancer and other device claims totaling $26,000 for that same patient were never given to the patient or needed at all.

Another example was a power wheelchair. The Medicaid fraud scheme illustrated comprehensive strategies to obtain government funds for items that were never needed or used. According to the Medicaid fraud lawsuit, the products were provided for more than a year before the business even opened and for patients who had been dead for longer than a year.

Although the government did not reimburse all of these claims, some of them were approved according to the Medicaid fraud lawsuit.

If you believe you have grounds to come forward with a whistleblower claim because you have become aware of illegal or fraudulent activity, consult with an experienced attorney.  The attorneys at Bradley/Grombacher are currently investigating whistleblower allegations of Medicaid fraud- fill out the form on this page to learn more about your rights.

The Medicaid fraud case is United States of America et al v. A Perfect Fit for You Inc. et al., Case No. 4:17-CV-00174 in the U.S. District Court for the Eastern District of North Carolina.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.