Attorney General's News Release
January 24, 2013
Attorney General Kosterís Medicaid Fraud Unit collected more than $50 million in 2012
Jefferson City, Mo.— Attorney General Chris Koster announced today that in 2012 the Medicaid Fraud Control Unit of the Attorney General’s Office collected more than $50 million and took action against 49 providers. In the past four years, the Attorney General’s Office has collected more than $202 million in Medicaid-fraud recoveries.
Koster’s Medicaid Fraud Control Unit is a national leader in cost-effectiveness. According to the latest available data from the U.S. Department of Health and Human Services, the Missouri Medicaid Fraud Control Unit collected $24.76 for each dollar spent in federal fiscal year 2011. Missouri was No. 2 in the region in recoveries per grant dollar and 3rd in the nation.
According to Koster, last year his office:
- Resolved criminal cases against 21 medical and home health-care providers. Three individuals served prison time, and 14 others will serve prison time if they do not meet all the terms of their probation. In the other four cases, the Attorney General’s Office negotiated settlements with the individuals.
- Resolved civil cases against 29 Medicaid providers, including one provider who was subject to both civil and criminal actions.
“My office is committed to aggressively pursuing medical and home health-care providers who are stealing from the taxpayers of Missouri by committing Medicaid fraud,” Koster said. “Our criminal prosecutions and our large monetary recoveries serve as a warning to providers who would consider submitting false bills to Medicaid: we are watching, and you will not get away with it.”
Highlights of Medicaid fraud cases in 2012 include:
- Abdullah Ali, LCSW: Abdullah Ali, of St. Louis, was a Licensed Clinical Social Worker (LCSW) providing counseling services in the St. Louis area. The Attorney General’s Office identified various unlawful schemes by Ali including: (1) Ali billed for family therapy sessions when services could not have been provided (as the parent was at work); (2) Ali’s own records indicated that he provided therapy services to two clients at different locations at the same time; and (3) Ali billed Medicaid for multiple sessions of family therapy for the same family on the same day, in violation of Medicaid rules.
On June 11, 2012, Ali pleaded guilty to three counts of Medicaid Fraud. Ali was sentenced to 5 years imprisonment and began serving his sentence last June. Ali also has paid more than $25,230 in overpayments and penalties.
- Comfort Dental (3 cases): Comfort Dental – a franchise dental chain based in Colorado with offices in the Kansas City area – billed Medicaid for services provided to individuals who were not eligible for Medicaid, resulting in a total loss to Medicaid of more than $17,000. Additionally, the Attorney General’s investigation revealed that each clinic double-billed services to Medicaid, resulting in a loss of more than $4,200, and also charged Medicaid recipients for services paid for by the program.
In three separate settlements, the entities paid $66,265.22 to resolve claims of both the Medicaid Fraud Control Unit and the Consumer Protection Division. The Consumer Protection Division sent checks totaling $6,265.22 to those Missouri citizens who were improperly billed for Medicaid covered services.
- Just What the Doctor Ordered, Inc.: Teresa Linneman, of Fayette, was the owner/operator of Just What the Doctor Ordered, Inc., a durable medical equipment company. The Attorney General’s Office found that Just What the Doctor Ordered billed Medicaid for more than 27,000 diapers that were never provided to Medicaid recipients. The actual damage to Medicaid for the 702 identified false claims was $36,890. The Attorney General’s Office has negotiated a Deferred Prosecution Agreement with Linneman, requiring Linneman to repay the state more than $217,000.
Koster said he encourages individuals to report suspected Medicaid fraud or abuse of Medicaid recipients to his office. As part of outreach efforts to identify and prosecute Medicaid fraud, Koster taped a public service announcement asking citizens to report fraud to his office and informing them that state law allows whistleblowers 10 percent of any Medicaid fraud money recovered as a result of their tip. The PSA can be viewed at: http://www.youtube.com/watch?v=Ulc__bnFMPI&feature=youtube.
Missourians can report suspected Medicaid fraud and abuse online at ago.mo.gov or through the Medicaid Fraud Hotline at 800-286-3932.