Provider welfare fraud recoveries during Rokita administration surpass $100 million

Submitted by Office of AG Todd Rokita

Indiana Attorney General Todd Rokita announced at a press conference on Tuesday, Feb. 24 that his Medicaid Fraud Control Unit (MFCU) has surpassed $100 million in provider welfare fraud recoveries since January 2021.

Rokita

“Today’s announcement is important for Hoosier taxpayers who are concerned about government fraud,” AG Rokita. “It is also important for our most vulnerable citizens who depend on Medicaid for their health care.”

One of MFCU’s duties is to investigate health care providers who intentionally defraud the state’s Medicaid program through deceptive billing practices. The sum of the $100 million represents recoveries of various amounts secured in 89 cases, some civil and criminal.

In addition to fraud, MFCU also investigates drug diversion and the abuse and neglect of patients at Medicaid-supported facilities. In criminal cases spanning all three of these categories, the unit since January 2021 has secured 252 indictments, 233 convictions, and 292 exclusions from being allowed to continue billing Medicaid and/or Medicare.

“I am here to congratulate this team but also note that this is an ongoing, effective effort of my office,” AG Rokita said. “As long as I am attorney general, it will continue to be a priority.”

MFCU’s achievement here in Indiana provides a marked contrast to the ways in which welfare fraud is making headlines in Minnesota and Maine – where federal investigators are looking into allegations that state officials, despite warning signs, failed to take measures to prevent plots to misdirect taxpayer funds intended for social programs.

“Here in Indiana, we will keep catching and helping prosecute perpetrators who purposefully exploit systems intended to help the poor,” AG Rokita said. “To steal resources from a program with that mission requires a special breed of despicable.”

Often, those committing this form of welfare fraud are professionals collecting money from the healthcare and medical fields – individuals familiar with technicalities in the Medicaid system who use their specialized knowledge to find ways to break the rules and feather their own nests without getting caught.

MFCU Director and Chief Counsel Matthew Whitmire described the MFCU’s accomplishments as resulting from a team effort.

“The successful recovery of $100 million by the Medicaid Fraud Control Unit reflects the importance of sustained efforts to fight fraud and protect the state Medicaid program’s fiscal integrity,” Whitmire said. “The hard work of the dedicated attorneys, investigators and auditors is reflected in this achievement and is a testament to their skill in combating fraud.”

The case that pushed MFCU’s total recoveries under AG Rokita past $100 million involved a former physician from Burlington, Indiana, who overcharged Medicaid by more than $1 million for urine samples. He did so by inflating the number of samples he collected and analyzed from patients seeking a prescription for opioid pills or other pain medicine.

The former physician, Don J. Wagoner, was also convicted of felony drug dealing. A $1.7 million settlement resulted from a case against Wagoner jointly filed by the U.S. Attorney’s Office for the Northern District of Indiana and the Indiana Medicaid Fraud Control Unit.

The Indiana MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a federal grant. The remaining 25 percent is funded by the State of Indiana.

Watch AG Rokita’s press conference announcing this milestone here.