Indiana Doctors Accused of Medicaid Fraud Scheme, Overbilling for Urine Samples

Authorities have come forward to allege a Medicaid fraud scheme involving more than $1.1 million in urine samples in Indiana. The two doctors are accused of defrauding the Indiana Medicaid program because they were over prescribing pain-killing medications that led to far too many patient deaths and overdoses.

Medicaid Fraud Scheme Involves Unnecessary Collection of Urine Samples

The physicians immediately surrendered their licenses in the Medicaid fraud scheme. They also stopped practicing medicine and prescribing drugs in 2013 after a state criminal investigation identified their fraudulent opioid prescription scheme.

The Medicaid fraud scheme involved more than 6,400 fraudulent claims to Medicaid involving totals of more than $1.1 million in illegal charges in Indiana. The physicians operated clinics in Kokomo and Burlington and defrauded Medicaid in the health care fraud scheme by exaggerating the number of urine samples collected and analyzed at the facility.

The claim was filed against the companies in the U.S. District Court in Northern District of Indiana, accusing the doctors of developing a comprehensive scheme to get as much money as possible from the state Medicaid program for billings that never should have existed in the first place.

Medicaid False Claims Often Shared by Whistleblowers

The government refers to these kinds of actions as false claims, and if discovered, these cases may lead to civil and criminal penalties. While the government has investigation teams to ferret out Medicaid fraud, many cases are brought to the government’s attention by a whistleblower, likely an employee in the company who became aware of the fraud.

In certain cases, whistleblowers will receive a portion of any recovered funds in a Medicaid fraud claim.

The false claims were submitted from 2011 to 2013, according to authorities. Each allegation involved billings of $171.21 for each patient. Medicaid rules, however, allowed the physicians to only bill $20.93 for each patient. The pair allegedly concealed the health care fraud scheme by claiming that they obtained at least nine urine samples from every patient, even though they only truly collected one.

State laws and federal laws allow authorities and any individual who becomes aware of Medicaid fraud schemes to recover as much as three times the amount of fraudulent and false medical claims. This is in addition to the civil penalties in any case which can rack up between $5,500 to $11,000 for every individual false claim. The maximum that could be charged to the doctors in this health care fraud scheme is over $70 million.

The 2013 criminal investigation handled by the state led to felony drug dealing convictions for one of the physicians due to the opioid prescription practices in the facility. The other person named in that case was ultimately found unable to stand trial due to memory loss and declining cognitive functions.

Any whistleblower who becomes aware of Medicaid fraud schemes and other indications of illegal activity may come forward and share it with the authorities without fear of retaliation. In certain situations, whistleblowers may also be entitled to recover damages if the case is ultimately successful. If you believe you have grounds for a whistleblower case, you should consult with the attorneys at Bradley/Grombacher. Fill out the form on this page to learn more.