Fox Announces Successful Prosecution of Medicaid Provider Fraud Case
Attorney General Tim Fox announced that a Seeley Lake chiropractor who recently pleaded guilty to defrauding Montana’s Medicaid program will pay $100,000 in restitution.
On September 25, 2019, the Montana Attorney General’s Office charged Dr. Andrew Lance Bohlman, 48, in Missoula County District Court with one count of Medicaid Fraud by common scheme, a felony.
“We all have an interest in making sure taxpayer dollars are spent as they should be,“ said Attorney General Tim Fox. “I commend our Medicaid Fraud Control Unit, our Division of Criminal Investigation, and Assistant Attorney General Mike Gee for protecting Montana’s public resources and securing a sentence tailored to both punish and rehabilitate this health care provider.”
On October 15, 2019, the defendant entered a guilty plea before Missoula County District Court Judge Jason Marks. After a pre-sentence investigation was conducted, the defendant was sentenced on December 2, 2019 to six years at the Montana State Prison, deferred, and placed on supervised probation. Bohlman was also ordered to pay $100,000 in restitution to the Montana Medicaid Program in addition to other court ordered fees.
The investigation by the Montana Department of Justice’s Medicaid Fraud Control Unit (MFCU) began after Blue Cross Blue Shield made a referral in September 2016 to MFCU as well as the Surveillance and Utilization Review Section at the Montana Department of Public Health and Human Services. Both state agencies began simultaneous investigations. Data review and interviews with patients and their parents revealed that from at least January 2012 to January 2016, Bohlman billed Medicaid almost exclusively for two types of chiropractic treatments on almost every single patient on every single visit. Both of the services have high-paying reimbursement rates.
Not only were some patients seeing Bohlman for ailments other than those related to their backs, but he was also billing for treatments that occurred when the patients weren’t there, were no longer patients, or prior to ever meeting them. Additionally, when asked by MFCU investigators to provide treatment documentation, Bohlman was only able to submit 51 valid and accurate medical records for over 1,700 dates of service.
On December 8, 2016, Medicaid payments to Bohlman were suspended as a result of DPHHS’s confidence that his billings were fraudulent. By that point, Bohlman had received at least $100,000 worth of public assistance monies based on the Medicaid claims he submitted.
Fox added, “The Montana Department of Justice will continue to seek out abuse of our public programs, and vigorously prosecute those who defraud the system. I encourage anyone who suspects Medicaid provider fraud to call our hotline at 1-(800)-376-1115.”
In 1995, the Montana Legislature created the Medicaid Fraud Control Unit, which became operational the following year. The MFCU is dedicated to investigating Medicaid patients’ quality of care and ensuring public funds go only to those health care providers who provide legitimate services.
Medicaid is a jointly funded, federal-state health insurance program for low-income people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments. Medicaid provider fraud occurs when a Medicaid provider knowingly makes, or causes to be made, a false or misleading statement or representation for use in obtaining reimbursement from the Medicaid program. A “provider” refers to doctors, hospitals, dentists, clinics, counselors, or any other entity that Medicaid pays to serve its members.