Attorney General Fox Reminds Montanans of Medicaid Provider Fraud Hotline Number
Attorney General Tim Fox reminded Montanans today the Montana Department of Justice maintains a hotline for citizens to report suspected Medicaid provider fraud.
“Stealing from Medicaid is like stealing from each and every taxpayer,” Attorney General Fox said. “Examples of Medicaid provider fraud include billing for services not performed, dispensing generic drugs and billing for brand-name drugs instead, and falsifying timesheets or signatures in connection with the provision of personal care services.” Attorney General Fox added, “The successful investigation and prosecution of two recent Medicaid fraud cases by our Medicaid Fraud Control Unit demonstrates our commitment to protecting the financial health of State resources and the quality of care available to Medicaid patients.” Attorney General Fox encouraged anyone who suspects Medicaid provider fraud to call the Montana Department of Justice’s hotline at 1-(800)-376-1115.
This spring in Yellowstone County, Brooks Johnson received a six-year deferred, probationary sentence and was ordered to repay the Medicaid program approximately $67,000. Johnson falsely claimed to be providing mental health therapy to his patients. One patient was as young as four months old.
Attorney General Fox also noted the Medicaid Fraud Control Unit’s (MFCU) cooperative investigation with the Montana Department of Public Health and Human Services fostered the successful prosecution of Kristi Rydeen in Powell County recently. The Rydeen case resulted in what is believed to be the first-ever Department of Corrections custodial sentence of a health care provider in a state MFCU investigation prosecuted in state court. Rydeen falsely claimed to be providing mental health therapy to numerous patients, many of whom were under the age of 18. Rydeen received a sentence of 20 years to the Department of Corrections, with 15 years suspended. Rydeen was also ordered to repay the Medicaid program approximately $57,000. Bryan Lockerby, administrator of the Division of Criminal Investigation at the Montana Department of Justice, credited the hard work of DCI agent Cody Danielson and MFCU staff in securing a sentence tailored to both punish and rehabilitate this health care provider.
In 1995, the Montana Legislature created the Medicaid Fraud Control Unit, which became operational the following year. In Fiscal Year 2014, MFCUs nationwide reported almost $300 million in criminal recoveries. In Montana, the amount of restitution ordered on MFCU cases since 1996 totals $2,964,903. 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.