Medicaid Fraud Cases
Dr. Aubrey Camacho, an obstetrician in Georgia, made his living ripping off Medicaid. To get higher reimbursement, Camacho billed Medicaid for Caesarean deliveries when he performed vaginal deliveries. He billed for patients who didn’t even know who he was and for seeing patients when he was not in the office. He also billed Medicaid for sonograms that were not provided or were not medically necessary, including 92 sonograms for one patient.
State auditors in Connecticut uncovered a durable medical equipment scam in 1998, finding that three DME companies routinely used the ‘miscellaneous’ code to bill up to $499 per item (billing $500 or more would have attracted attention). Each of the companies allegedly failed to maintain physicians’ prescriptions, failed to maintain invoices to support billing and billed for non-covered items.
Rayonne Clark pleaded guilty to Medicaid fraud for her role in fraudulently obtaining admission into the Medical Family Care Program. She worked for Maximus, a contractor hired by New Jersey to assist eligible residents obtain health insurance and other medical benefits.
Alabama convicted pediatrician Nival Miller of Medicaid fraud in June 2001. She pleaded guilty to billing for many services that she did not provide, including: breathing treatments, hearing tests, and antibiotic injections.
“This doctor not only defrauded the State of money that was intended for treatment of needy and deserving patients, but may well have placed her own patients’ health at risk with inappropriate tests and treatment,” said Alabama Attorney General Bill Pryor. “We are grateful to the principled former employees who brought this matter to the attention of authorities.”
Several of the nation’s largest laboratories billed Medicaid and Medicare for millions of unneeded tests during the late 1980s and early 1990s. The labs used forms that seemed to package uncommon lab tests with commonly ordered blood panels. Doctors were tricked into thinking the additional (and unnecessary tests) were provided at no extra charge. In fact, these extra procedures were billed to Medicare and Medicaid.