Woodville Woman Faces up to 5 Years, $250K Fine for Social Security Fraud, Health Care Fraud and Theft of Public Money
PORTLAND, Maine: United States Darcie N. McElwee today announced that Gary S. Winn, D.O. of Arundel, has agreed to pay $330,607 to settle allegations that he had violated the False Claims Act.
The civil settlement agreement between Winn and the United States and the State of Maine resolves allegations that Winn, the former medical director and owner of a family medical practice in Biddeford and Sanford, Provider’s Care, submitted false claims to Medicare and MaineCare (Maine’s Medicaid program) from January 2014 through November 2017. MaineCare is funded primarily by the federal government, which pays approximately two-thirds of all reimbursed claims.
On April 27, 2023, the United States filed a Complaint against Winn in the United States District Court for the District of Maine. As alleged in the Complaint, Medicare and MaineCare statutes, regulations and guidelines make clear that participating providers may only bill for services actually provided and which are medically reasonable and necessary. The United States and Maine contended in their Complaint that from January 2014 through November 2017, Winn knowingly submitted to Medicare and MaineCare claims for payment for medical services that were not provided or were not medically reasonable or necessary, including osteopathic manipulation treatment (OMT) services, evaluation and management services, tobacco use cessation counseling visits, outpatient visits, and patient drug testing services.
The Complaint against Winn was brought by the United States pursuant to the False Claims Act (FCA), as well as Maine’s false claims statute. The FCA provides that any person who “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval” or “knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim” is liable to the United States for three times the amount of damages which the United States sustains, plus a civil penalty for each FCA violation. As alleged in the Complaint, by submitting claims for payment for medical services that were not provided or were not medically reasonable or necessary, Winn violated the FCA.
The U.S. Department of Health & Human Services, Office of Inspector General, the U.S. Attorney’s Office for the District of Maine, and the Office of the Maine Attorney General investigated the case. The civil action is docketed United States & State of Maine v. Gary S. Winn, 23-cv-00186-JDL (D. Me.).
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John G. Osborn, Assistant United States Attorney (207-780-3257)