Hickory, N.C. Physician Pleads Guilty To Health Care Fraud
CHARLOTTE, N.C. – A Hickory physician pleaded guilty today to health care fraud charges for submitting to Medicare and Medicaid over $467,376 in fraudulent reimbursement claims, announced Jill Westmoreland Rose, Acting U.S. Attorney for the Western District of North Carolina. Wayne Vincent Wilson, 54, entered his guilty plea before U.S. Magistrate Judge David S. Cayer.
Acting U.S. Attorney Rose is joined in making today’s announcement by Derrick Jackson, Special Agent in Charge, Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Office of Investigations, Atlanta Region.
According to filed court documents, Wilson is a licensed family practitioner and owner and operator of Wayne Wilson, MD Family Practice (the Practice) located in Hickory. At today’s plea hearing, Wilson admitted that from 2007 to 2014, he engaged in a scheme to defraud Medicare and Medicaid by submitting fraudulent reimbursement claims totaling more than $467,376 for services that were never provided to beneficiaries. The fraudulent claims resulted in payments of at least $210,120 to Wilson and the Practice.
According to plea documents, Wilson “added and padded” his Medicaid and Medicare reimbursements with these false claims because he believed that Medicaid did not pay him enough for his services. Court records show that in some instances Wilson perpetrated the fraud by adding non-existent services, such as nerve conduction studies, strep tests, and pulmonary stress tests among others, to actual patient office visits. In other instances, Wilson fabricated entire office visits and submitted fraudulent claims for dates that patients were not even seen at the office.
According to admissions reflected in the plea documents, beginning in 2005, Wilson contracted with an individual identified as “D.D.” to perform nerve conduction studies, and sought reimbursement for those services through the Practice. In February 2012, D.D. terminated his relationship with Wilson and the Practice. Court records show that Wilson continued to submit fraudulent reimbursement claims to Medicare and Medicaid, falsely stating that he had performed nerve conduction studies for beneficiaries, even though Wilson did not have the equipment or the expertise to provide such studies.
Wilson pleaded guilty to two counts of health care fraud and was released on bond after the hearing. The maximum prison term for each health care fraud count is 10 years and a $250,000 fine. Wilson has also agreed to pay restitution, the final amount of which will be determined by the Court at sentencing, which has not been set yet.
HHS-OIG conducted the investigation. HHS-OIG conducted the investigation. The prosecution of the case is handled by Assistant U.S. Attorney Kelli Ferry and Special Assistant U.S. Attorney Timothy Rodgers. Mr. Rodgers is a Special Deputy Assistant Attorney General with the North Carolina Department of Justice Medicaid Investigations Division. The SAUSA position is reflection of the partnership between the Medicaid Investigations Division and the United States Attorney that helps ensure the effective and vigorous prosecution of Medicaid fraud.
The investigation and charges are the work of the Western District’s joint Health Care Fraud Task Force. The Task Force is multi-agency team of experienced federal and state investigators, working in conjunction with criminal and civil Assistant United States Attorneys, dedicated to identifying and prosecuting those who defraud the health care system, and reducing the potential for health care fraud in the future. The Task Force focuses on the coordination of cases, information sharing, identification of trends in health care fraud throughout the region, staffing of all whistle blower complaints, and the creation of investigative teams so that individual agencies may focus their unique areas of expertise on investigations. The Task Force builds upon existing partnerships between the agencies and its work reflects a heightened effort to reduce fraud and recover taxpayer dollars.
If you suspect Medicare or Medicaid fraud please report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.