Things That Go Together

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Some things go together perfectly like salt and pepper, peanut butter and jelly, or shoes and socks. The owner of a Milwaukee, Wisconsin mental health clinic tried to use an interesting combination of urine tests and offshore telemedicine therapy to carry out a Medicaid fraud scheme. (That’s certainly unique. It doesn’t exactly roll off the tongue as easily as macaroni and cheese.) However, the clinic owner’s effort to profit from the illegal scheme failed and he has agreed to repay the federal government $4.1 million.

The owner of the Milwaukee medical clinic provided care to some of the neediest patients in the State of Wisconsin, many of whom were suffering from mental health and drug dependency issues. In fact, today’s article states that the Milwaukee clinic collected 99 percent of all Medicaid payments made to mental health and substance abuse counseling providers in the state over a four-year period. (I’m sure Medicaid administrators took note of the increase in Wisconsin’s Medicaid reimbursement rates that grew from $332,000 to over $7.3 million in three years.)

Instead of treating the Medicaid patients to help them overcome their addictions, the medical clinic owner used them to bill the government healthcare program for unnecessary services so revenue would increase. The clinic owner required every patient who walked through the door to have a urine test, whether they were seen for drug abuse or for mental health issues. Standard pee-in-a-cup tests that cost the clinic $5 were billed at $20, but most of the time the clinic employees up-coded the tests as more complex screens that provided a $230 reimbursement.

As revenues grew, so did the scheme. The clinic eventually purchased machines that screened urine for specific drugs. The owner directed employees to bill every client for the specialized screen, even if the initial test was negative. (Medicaid got stuck with a $474.66 bill for each test screened in-house.) His clinic also provided telehealth services using psychiatrists located outside of the United States. (This is an illegal practice.)

Thanks to a nurse practitioner who worked at the Milwaukee medical clinic, the Medicaid fraud scam was revealed in a whistleblower lawsuit in 2013. As a result, the clinic owner agreed to a 20-year ban from participating as a provider with Medicaid and Medicare. His son, who helped run the clinic, is banned for five years. The owner and the clinic have agreed to pay approximately $4.1 million in cash and other compensation to the federal government and the State of Wisconsin. (While the whistleblower is entitled to receive up to 30% of the settlement, it is likely that the reward will be between 15 and 20 percent of the recovery.)

There are so many ways to commit Medicaid fraud. The federal government won a game of hide and seek with today’s defendant, who tried to misrepresent the truth to obtain an unauthorized benefit. After weighing the pros and cons of punishing the clinic owner for his illegal actions, the government decided on a combination of punishments. The Milwaukee clinic was shut down by the government and now the clinic owner must pay back what he stole. (That sounds a lot like sugar and spice, and everything nice.)

Today’s “Fraud of the Day” is based on an article entitled, “Owner of closed Milwaukee clinic to pay $4.1 million over fraudulent urine screens,” published by Journal Sentinel on March 29, 2019.

The owner of a shuttered Milwaukee mental health clinic has agreed to repay the federal government $4.1 million for overbilling Medicaid for unnecessary urine tests and offshore, telemedicine therapy.

From 2011 to 2015,  Acacia Mental Health Clinic LLC, 5228 W. Fond du Lac Ave., captured 99% of all Medicaid payments to mental health and substance abuse counseling providers in Wisconsin, according to federal prosecutors who sued to claw back some of that money.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.