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Medicaid Fraud Case Examples

Prosecuted by the Medicaid Fraud Control and Elder Abuse Unit

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  • A private duty nurse received a suspended sentence of 12 years incarceration, was placed on four years probation to include one year incarceration, and was ordered to pay $9,298 in restitution. The defendant was charged with billing Medicaid for dates and times she was not at the patient’s residence. She was also charged with Child Neglect Causing Bodily Harm for neglect that resulted in the child needing emergency treatment for dehydration and malnutrition. The child did not survive.

 

  • An owner of a personal care agency was sentenced to six months incarceration and five years probation and was ordered to pay $568,403 in restitution. As the owner of the agency, she used her ten employees to bill Medicaid for services not rendered and travel time that had not occurred.

 

  • A caregiver received a suspended sentence of 27 months incarceration, was placed on three years probation, and was ordered to pay $37,186 in restitution. The woman billed Medicaid for services alleged to have been provided in Milwaukee during a time the woman and recipient lived out of state.

 

  • A personal care agency owner and nurse was sentenced to five years imprisonment comprised of two years initial confinement followed by three years of extended supervision, and was ordered to pay $1,522,307.56 in restitution. As the owner of a personal care agency, she billed for almost 95,000 hours of care to disabled children that was not provided and received over $1.5 million from the Medicaid program. She also forged doctors’ signatures on orders to approve the services.  

 

  • The owner of a durable medical equipment (DME) company was sentenced to a total of twelve years imprisonment, comprising five years initial confinement and seven years extended supervision, and was ordered to pay restitution in the amount of $257,376.58. The defendant submitted payment claims to Wisconsin Medicaid for DME used for orthotic purposes. Investigation found that the Medicaid recipients for whom the devices were allegedly provided did not know the defendant nor have need for such orthotic devices.