Grand Jury Returns 12-Count Indictment Charging Utah County Man With Health Care Fraud, Wire Fraud
SALT LAKE CITY -- A federal indictment unsealed this week charges Dustin Joseph Long, age 29, of Santaquin, with six counts of health care fraud and six counts of wire fraud in connection with what the indictment alleges was a scheme to defraud Humana, a health care benefits program. The indictment alleges the fraud scheme resulted in more than 900 fraudulent claims being submitted to Humana resulting in payments exceeding $700,000.
Long was arrested Tuesday morning in Orem. He appeared for an initial appearance on the charges Tuesday afternoon before U.S. Magistrate Judge Dustin Pead and entered a plea of not guilty to the charges. Magistrate Pead released Long from custody and imposed a variety of conditions of release. A five-day jury trial has been set for March 17, 2017, before U.S. District Judge Clark Waddoups.
Long was co-owner and primary operator of two drug and alcohol treatment centers in Utah, collectively referred to as Arcadia in the charging document. Arcadia Recovery Center was a drug and alcohol outpatient treatment center located in Payson. Arcadia Residential Treatment Center was a drug and alcohol intensive outpatient treatment center located in Bluffdale.
Arcadia used a third-party biller, CloudMedBilling (CMB), to prepare, submit, and track claims submitted to health care benefit program. Long was a co-owner of CMB. In the normal course of CMB’s business, drug and alcohol treatment centers provided CMB login access to drug and alcohol treat records maintained by BestNotes, a web-based records keeping system based in Twin Falls, Idaho. The access allowed CMB to submit complete and accurate claims on behalf of drug and alcohol treatment centers.
According to the indictment, from around January 2015 to October 2015, Long devised and executed a fraud scheme to obtain money from Humana. The indictment alleges that as a part of the execution of the scheme, Long caused fraudulent insurance claims to be submitted from Arcadia to Humana for drug and alcohol therapy and treatment services not rendered. The claims resulted in payments to Arcadia under false pretenses.
According to the indictment, Long had exclusive control over Arcadia claims submitted to Humana, which were prepared and submitted by CMB. The indictment alleges Long emailed CMB weekly “rosters” reflecting drug and alcohol therapy treatment services allegedly provided to Humana-insured Arcadia clients on specific dates. Acting at Long’s direction, CMB employees prepared and submitted claims to Humana based on the rosters. Long had exclusive control over all information provided to CMB.
The indictment alleges that despite numerous requests, Long denied CMB employees access to BestNotes, the most accurate source of Arcadia client information available, to prepare claims and to verify the accuracy of the rosters provided by Long. Other drug and alcohol treatment centers routinely provide CMB employees access to BestNotes to ensure accurate information claims seeking payment for drug and alcohol treatment services.
In late June 2015, CMB discovered that Long’s rosters falsely identified continued drug and alcohol therapy and treatment services well past Arcadia clients’ discharge dates, the indictment alleges. Although CMB notified Long about the billing discrepancies and the need to take remedial action, Long failed to correct any billing errors, did not refund money to Humana, and continued to submit false and fraudulent rosters to CMB for claims processing until October 2015.
The indictment alleges that from around January 2015 to around October 2015, Long caused more than 900 fraudulent claims to be submitted to Humana involving about 14 clients resulting in total payments from Humana to Arcadia exceeding $700,000.
The potential maximum penalty for each of the six health care fraud counts in the indictment is 10 years and a fine of $250,000. The wire fraud counts each carry a potential 20-year penalty and a fine of $250,000.
Indictments are not findings of guilt. Individuals charged indictments are presumed innocent unless or until proven guilty in court.
The case is being prosecuted by the U.S. Attorney’s Office in Salt Lake City and is being investigated by special agents of the FBI.