OFFICE OF ATTORNEY GENERAL MEDICAID FRAUD CONTROL UNIT (MFCU)

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Presentation transcript:

OFFICE OF ATTORNEY GENERAL MEDICAID FRAUD CONTROL UNIT (MFCU)

MFCU FY2012 Total Recoveries:$2,531,736 Total Budget:$388,183 25% State Share $97,046 75% Federal Share $291,137 Return on Investment: $6.52 per $1 spent

MFCU FY2012 Cases Opened:44 Closed:50 Pending:30

MFCU FY2013 (through Dec. 14, 2012) Total Recoveries:$7,388,048 Total Budget:$396,605 25% State Share $99,151 75% Federal Share $297,454 Return on Investment: $18.63 per $1 spent

MFCU FY2013 Cases (through Dec. 14, 2012) Opened:9 Closed:17 Pending:22

MFCU Majority of Recoveries come from out of state Pharmaceutical companies. Vast majority of Providers in South Dakota are honest and ethical. These recoveries benefit South Dakota taxpayers.

MFCU Notable Case Cary Feldman – former optometrist in Rapid City Largest criminal health care provider fraud case ever prosecuted in South Dakota, in either State or Federal Court. $362,457.90Medicaid Restitution +__ $592.00Medicare Restitution $363,049.90Total Restitution $363, $80,000.00Check - $157,000.00Coin Collection $126, Remaining Restitution to be paid

MFCU Notable Case cont. Feldman was convicted of: Grand Theft by Deception (Class 4 Felony) Making False Medicaid Claims (Class 5 Felony) Sentence: Grand Theft by Deception – 10 years (the maximum) Making False Medicaid Claims – 5 years (the maximum) Suspended Execution – 15 years probation – Pay all restitution – Serve 6 months in county jail – Optometry Board revoked his license – Will be placed on OIG Exclusion List

MFCU Notable Case cont. Feldman case was investigated and prosecuted by MFCU, with assistance from: South Dakota Department of Social Services Federal Department of Health and Human Services Office of Inspector General South Dakota Division of Criminal Investigation Spearfish Police Department Rapid City Police Department Pennington County Sheriff’s Office Pennington County Office of State’s Attorney Minnehaha County Sheriff’s Office South Dakota Office of United States Attorney South Dakota Board of Examiners in Optometry South Dakota Property Management (sale of coin collection) Feldman case is a good example of State, Federal, and Local teamwork – we leverage government resources to achieve results in a cost-effective manner.