October 12, 2010
Jefferson City, Mo.- Attorney General Chris Koster said today that Dr. Howard Goldstein, a St. Louis psychiatrist, has agreed to pay the state Medicaid program for "upcoding" his Medicaid reimbursement records and SSM St. Charles Clinic Medical Group and SSM Healthcare Corporation agreed to repay Medicaid funds it should not have received based on Goldstein's fraudulent billings.
Missouri will receive $176,748.00 of the $441,870.00 Medicaid portion of the settlements as its share based on the federal and state joint funding of the Medicaid program.
Koster said Goldstein, who worked for SSM St. Charles Clinic Medical Group and SSM Healthcare Corporation, engaged in "upcoding," a scam whereby he would bill Medicaid for more work than he actually performed. For instance, Goldstein would actually spend five minutes or less with a patient and then bill Medicaid for a 20-minute session.
Koster applauds SSM for coming forward and reporting Goldstein's fraudulent billings when it was discovered during a routine peer review process. Koster said in addition to the settlement with Goldstein, SSM has agreed to reimburse the state for Medicaid payments it received based on Goldstein's fraudulent billings.
"One of my top priorities as Attorney General is to go after those who are cheating Missouri taxpayers by committing Medicaid fraud," Koster said. "This kind of outrageous conduct steals medical resources that would otherwise be directed to truly needy Missourians."
Koster said in addition to the state settlement, Goldstein has pled guilty to the federal felony of making a false statement to the Federal Bureau of Investigation during the investigation of his Medicaid and Medicare billings, for which he faces up to five years in prison and/or fines up to $250,000 when he is sentenced on January 5, 2011. He also agreed to pay the United States $830,000 in a related civil settlement agreement.
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint or complete a complaint form at the Attorney General's Medicaid Fraud Website.