Friday, December 12, 2014

Commissioner William McClure & Mother Medicare Fraud Affidavits Unsealed

Records: St. Johns County Commissioner McClure, mother accused of overbilling Medicaid, Medicare
Posted: December 12, 2014 - 7:36pm
Newly unsealed search warrant documents show that state and federal investigators believe St. Johns County Commissioner Bill McClure and his mother, Paula Stowell, falsely billed Medicaid and Medicare, forged prescription documents and kept controlled substances at their medical offices without certification.
The accusations are in relation to the two county locations of the Medi M.D. clinics, and they are revealed in search warrant records that have recently been made public.
The Florida Attorney General’s Office served warrants at the clinics in Palencia and on South Plantation Island Drive on Oct. 9, taking office computers, boxes full of documents and even containers believed to hold controlled substances.
On that day, a basic version of the search warrant was released that said the clinics were being investigated for possible charges of: Health care fraud, conspiracy to commit health care fraud, Medicaid Provider fraud, grand theft, falsifying a death certificate and practicing medicine without a license.
In the detailed version obtained Friday from the St. Johns County Clerk of Courts office, the warrant includes a report detailing specific unlawful acts that McClure and Stowell are accused of. The accusations are based on interviews of mostly former employees of the clinics.
McClure said he couldn’t comment directly on any of the accusations.
Although the search warrants were served more than two months ago, McClure said it was just this week that he was able to see the affidavit from investigator Mark Linde and signed by Circuit Court Judge David Walsh of Flagler County.
“I’m disappointed in the misinformation given to investigators,” McClure said. “It’s a one-sided story and I’m eager to present my side to the Attorney General.”
According to the affidavit establishing probable cause, the investigation of the Medi M.D. clinics began on Feb. 5 when a woman named Angela Carr notified the Attorney General’s Office that she believed Medicaid fraud was being committed. She was one of several former employees cited in the report who accused the clinic of fraud.
Investigation ongoing
McClure’s attorney, Mark S. Barnett of Fallgatter & Catlin, P.A., said they were still going through the state’s findings.
“From the outset of this case, we have cooperated fully with the Attorney General’s Office and will continue to do so,” Barnett said in an email. “Naturally, an application for a search warrant is a one-sided document, that is based on hearsay, and often includes information from persons who are either lacking knowledge, or have an honest misunderstanding.
“We had no notice of their presentation, and no opportunity to respond, or set the record straight. Now that these documents have been made public, we have the opportunity clarify and correct these issues. Once the truth comes out, Mr. McClure’s good name will be cleared, and he can continue as the outstanding public servant that he is. We are committed to the truth, and confident that, once the truth is known, this investigation into Bill McClure will be closed.”
No charges have been filed. On Friday, the Attorney General’s Office press secretary, Whitney Ray, would only say that the investigation is “active and ongoing.”
Carr was a patient at one of the clinics in November 2013 and worked for the clinics from December 2013 to February 2014. She was interviewed by investigator David Schwab and claimed that Stowell and others billed Medicaid and Medicare for services that were not rendered.
“They charge for another office visit for like therapy on a Friday even though the patient came in on the one day,” Carr said, according to the document. “So they would charge an office visit for two different days on a day that they wouldn’t even be seeing patients. Then there are some office visits that were even dated on Sunday. So there was a lot of it, seemed like everybody was being double billed when it came to Medicaid and Medicare.”
Another former employee, Celeste Laster, told investigators that McClure told her to change the billing codes from the service actually performed to something with a higher reimbursement rate from Medicare.
Former employees give statements
Latonia Maier, also a former Medi M.D. employee, said in an interview with investigators that she had witnessed fraudulent billing. Even more serious, she said that she personally witnessed Stowell fill out narcotic prescriptions and issue them without a doctor’s knowledge. Stowell is a nurse practitioner.
Among the controlled substances Maier said Stowell prescribed were Adderall, Concerta, Vyvanse and Valium (Schedule II substances according to state law).
A Medi M.D. employee named Sydney Smith said she was fired after working there for a little more than a year because she questioned the company’s billing practices.
Donna Dalton, who worked for Medi M.D. for about two years, said she was directed to bill Medicaid and Medicare for dates of service not consistent with actual visits.
Among the most serious accusations were the ones made by former Medi M.D. employee Rose Ann Smith. She said that she personally saw Stowell forge a doctor’s name on prescriptions and that she was directed to bill the government for two visits for each one made.
Another interview was conducted by investigators on Sept. 4 of Cedelia Triggs, who was a Medi M.D. employee at the time.
Triggs said during the phone conversation that bottles labeled at “testosterone” were currently being stored at the clinic on South Plantation Island Drive. Linde wrote in the report that Medi M.D. is not licensed to store controlled substances at its clinics.
Another investigator, Emmanuel Ignacio with the Medicaid Fraud Control Unit, said in a report that Medi M.D. had been reimbursed for 21 Medicaid recipients for services provided by Stowell on dates in which she was out of the country.
Ignacio also reported that Medi M.D. had been reimbursed for 18 Medicaid recipients for services provided by Dr. Lindsay Israel-Gaines on dates in which the doctor was out of the country.
The affidavit concludes with a report from Special Agent Brett Rowland of the U.S. (sic) [Florida] Dept. of State.
Rowland determined that: “Medi M.D. Medicare claims data is (sic) consistent with information provided by cooperating witnesses, indicating that Medi M.D. is currently and has been engaged in a scheme to defraud the Medicare Fund.”
McClure has continued his duties as a commissioner during the investigation, and the clinics remain open. McClure said that when the entire process is over, it will be clear that he did nothing illegal.
“Every allegation is defensible,” he said.

No comments: