HAMMOND – United States Attorney for the Northern District of Indiana, David Capp, announced that Wanda C. Shorter, 43, of Elkhart, Indiana, was found guilty, yesterday, after a four-day jury trial of all four counts charged by indictment in a health care billing fraud/aggravated identity theft case.
According to documents in this case, Empowerment Non-Emergency Medical Transportation, Inc. (hereafter "Empowerment") was an enrolled Medicaid provider. The provider agreement for Empowerment showed that it was a commercial ambulatory service provider and that its business address was in Elkhart, Indiana. Defendant Wanda C. Shorter founded Empowerment and submitted Empowerment's billings to Medicaid for payment and reimbursement of claims. Ms. Shorter was the sole owner of Empowerment Non-Emergency Medical Transportation, Inc. Indiana Medicaid reimburses enrolled health care providers, including commercial ambulatory service providers, for covered services that are provided to patients who are Medicaid eligible on the date of the provided service. Providers enrolled in the Indiana Medicaid program agree to submit claims for only medically and reasonably necessary services that are covered under the program that are actually provided and to only seek compensation to which the provider is legally entitled. Under the Indiana Medicaid Provider Agreement the State of Indiana entered into with all Medicaid providers, Medicaid providers are prohibited from submitting claims for services that are not medically necessary or are not actually provided or for which the provider is otherwise not legally entitled to receive payment. From 2011 to 2014, in the Northern District of Indiana, the defendant knowingly engaged in a scheme to defraud Indiana Medicaid and knowingly misused the means of identification of Medicaid clients. As part of the fraud scheme, the defendant caused billings and claims for reimbursement to be sent to Indiana Medicaid for transportation services that were never in fact provided. Defendant Wanda Shorter caused billings and claims for reimbursement to be sent to Indiana Medicaid as well for the payment of inflated mileage claims and for medical transportation trips that had been cancelled and never occurred. Further, the defendant caused billings to be sent to Medicaid that were up-coded, that is, the defendants caused billings to be sent that were submitted for higher reimbursement amounts than were justified based on the actual transportation services provided. As part of the fraud scheme, the defendant knowingly used without lawful authority a means of identification of other persons during and in relation to her health care fraud scheme, including specifically that of multiple Medicaid beneficiaries. The loss caused by the fraud here was in excess of $1 million dollars.
“This case is an example of a brazen misuse of taxpayer funds by fraudulently overbilling the Medicaid program for reimbursements. It also demonstrates how state and federal government can partner to investigate and bring a perpetrator to justice. I want to once again personally thank David Capp and his team for their extraordinary efforts in serving justice and the people of Indiana,” said Indiana Attorney General Greg Zoeller, who also thanked the investigators and attorneys who worked on the case.
This case was prosecuted as a result of an investigation by the Federal Bureau of Investigation and the Indiana Attorney General’s Office Medicaid Fraud Control Unit. This case was prosecuted by Assistant United States Attorney Donald J. Schmid.
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