Wagoner Medical Center, LLC. and the center’s former physicians are facing a civil Medicaid fraud and abuse complaint for filing false claims, the U.S. Department of Justice reports.

The former physicians facing the Medicaid fraud claims are Don Wagoner, M.D. and Marilyn Wagoner, M.D., of Burlington, Ind.

According to the DOJ, the couple practiced medicine together at Wagoner Medical Center between 2011- 2013. Allegedly, it was during that time that the physicians would require patients seeking a prescription for pain or opioid medication to submit a urine sample used to test the presence or absence of nine or more drugs.

The multiplexed screening kit used for the qualitative drug testing cost the defendants no more than roughly five dollars, and the physicians tested every urine sample for the same patient on the same day. Through the alleged Medicaid fraud scheme, they falsely certified that they collected and analyzed nine or more separate urine samples per patient when they only collected and analyzed one urine sample.

Although Indiana Medicaid billing rules only allowed the defendants to bill $20.83 for every patient, the physicians allegedly billed Indiana Medicaid and received $171.27 for each patient instead.

The physicians allegedly filed over 6,400 claims and received a total overpayment of over $1.1 million from Indiana Medicaid.

According to the DOJ, through the federal False Claims Act and the Indiana Medicaid False Claims Act, the federal government and the State of Indiana can recover three times the amount of Medicaid fraud and abuse claims submitted to Indiana Medicaid.

The federal government can also recover $5,500 to $11,000 for each false Medicaid claim submitted. To cover a cost for future Medicaid fraud investigations and cases, three percent of the recovery can go towards these costs through the federal False Claims Act.

In 2013, in connection with a state criminal investigation, the Wagoners surrendered their licenses to practice medicine and prescribe medications. The investigation was tied to their opioid-prescribing practices and resulted in felony drug dealing convictions for Don Wagoner.

According to the U.S. Attorney, “Although they no longer are endangering vulnerable Medicaid patients by practicing medicine, former physicians…cannot be allowed to retain the fruits of their fraudulent Medicaid claims,” he stated. “My Office will continue to make it a priority to pursue investigations and cases to recover funds that were fraudulently received from the Medicare and Medicaid programs.”

According to the Indiana Attorney General, “Working to recover taxpayer funds taken through fraud and other illegal means is part of our responsibility as stewards of the public trust,” he stated. “We appreciate the collaboration of our federal partners in this particular case, and we intend to remain vigilant going forward to make sure monies set aside to help society’s most vulnerable members are truly used for that purpose.”

The Department of Justice’s Commercial Litigation Branch have given increasing attention and priority to the civil prosecution of health care fraud, including Medicaid fraud.