CHEYENNE, Wyo. — Two recent Medicaid fraud convictions reflect increased vigilance against infractions and greater public awareness about the problem, according to the director of the Wyoming Medicaid Fraud Control Unit.
“We’ve had really good referrals coming in and most of our cases are leading to prosecutions,” Christine Stickley said.
In the most recent convictions, an Ethete woman, Margarita Toineeta-Curtis, and a Cody woman, Melody Sell, were convicted of defrauding the Medicaid program, according to a release from Wyoming Attorney General Greg Phillips.
Toineeta-Curtis submitted fraudulent time sheets claiming that her daughter provided services for her husband when her daughter lived out of state.
Toineeta-Curtis was originally charged with eight counts of Medicaid fraud and two counts of forgery. She pleaded guilty and was convicted of two counts of Medicaid fraud and was sentenced to a suspended two- to four-year prison sentence, placed on five years of supervised probation and ordered to pay $23,114 in restitution to Wyoming Medicaid.
The case was investigated by the Medicaid Fraud Control Unit of the attorney general’s office and prosecuted by the Fremont County attorney’s office.
Sell was convicted and sentenced to a suspended two- to four-year prison sentence. She was placed on four years of supervised probation for fraudulently billing Wyoming Medicaid for services she did not provide.
She was ordered to pay $22,704 in restitution to Wyoming Medicaid.
Sell provided rehabilitation services to developmentally disabled Wyoming Medicaid recipients through her business, Achieving Independence. Sell billed Wyoming Medicaid for a 12-month period in 2007-08, certifying that she provided services for a client when that client was actually hospitalized or in the Park County Detention Center, according to the Wyoming attorney general’s office.
Stickley said her agency has been trying to better inform people in the Medicaid program and in communities what the unit does and how to file a referral and a complaint.
In fiscal year 2010, the most current data, her office opened nine cases. Most cases were referrals, but many did not rise to the level of fraud or criminal activity.
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Stickley said she sent back the non-criminal cases so that the Medicaid program could recover internally the money that was wrongly spent.
“The public is more aware,” she said. “We’re getting more calls from the public, more questions about how things work.”
According to one national estimate, 3 to 10 percent of all government health care dollars, including Medicaid and Medicare, are spent fraudulently, she said.
Wyoming’s budget for Medicaid services was $508 million for fiscal year 2010.
Even at the 3 percent estimated fraudulent spending rate, the loss would be $15 million a year — money that did not go to services for low-income people in the Medicaid program.
Wyoming now serves about 66,000 Medicaid clients.
The Medicaid fraud unit has claim forms online that ask for the name of the provider the individual is concerned about.
A complaint from a Medicaid agency is more likely to involve a billing issue. A client, for example, may contact the unit to report being billed for an office visit when the client was out of state and never saw the doctor.
In some cases, people who work for a doctor call about a questionable practice that they’re afraid is illegal.
“We just need to know the name of the doctor and the suspicion you have,” Stickley said.
Medicaid is a program for low-income people. Medicare is a program to help pay medical expenses for people more than 65 years old.
In addition to Medicaid fraud, the Wyoming Medicaid Fraud Control Unit also investigates and prosecutes instances of elder abuse or neglect.