Social Worker Sentenced For Health Care Fraud
Madison, Wis. - John W. Vaudreuil, United States Attorney for the Western District of Wisconsin, announced that defendant Dennis J. Vandermause, 65, Spokane, Wash., was sentenced this week by U.S. District Judge Barbara B. Crabb to five years probation, and a fine of $10,000 dollars for defrauding Wisconsin's Intensive In-Home Treatment Services Program. He was also ordered to pay $114,713.89 in restitution.
Vandermause voluntarily agreed to a ten-year exclusion from Medicare, Medicaid, and all other federal health care programs. Vandermause pleaded guilty on October 10, 2012. His advisory guidelines sentencing range was 24 to 30 months in prison.
Vandermause was originally indicted on December 12, 2011, with sixteen counts of health care fraud arising from falsely billing for services to the Wisconsin Intensive In-home Treatment Services program between January 2004 and January 2008. The program is a Wisconsin Medicaid program established to provide in-home mental health and substance abuse treatment services for Medicaid recipients under 21 years old. On April 18, 2012, a federal grand jury sitting in Madison, Wis., returned a forty-three count superseding indictment against Vandermause, which re-alleged the original sixteen counts of false billing, and added twenty-seven counts of false billing and submitting false progress notes to justify the false billing.
The Wisconsin Intensive In-home Treatment program is funded, in part, by the United States Government under the Medicaid program. Under the program, all providers are required to prepare and maintain a truthful, accurate, and complete clinical record for each recipient that contains the recipient’s treatment plan and progress notes, signed by the performing provider. In addition, the services must be performed to receive payment from Medicaid. Vandermause was a Licensed Clinical Social Worker in Wisconsin who owned and operated the Family Resource Group, a certified Wisconsin mental health provider located in Madison which had numerous therapists operating under Vandermause's direction. Both the Family Resource Group and Vandermause were certified to deliver services under the program, which they did between 2004 and 2008. Vandermause left the Family Resource Group and moved from Madison to Washington in 2006, though he continued to see and bill clients in Wisconsin.
In response to a March 14, 2007 Wisconsin Bureau of Health Care Program Integrity audit, which requested progress notes to substantiate certain claims made by Vandermause between January 1, 2004 and December 31, 2005, Vandermause submitted over 800 false and fraudulent progress notes. These notes falsely documented services that were never performed and were manufactured at Vandermause's direction by therapists employed by him. The notes contained forged signatures, false information concerning patients and the alleged time spent with the patients, and duplicated identical progress notes for the same or different patients.
The charges against Vandermause were the result of an investigation by the Wisconsin Department of Justice, Medicaid Fraud Control Unit, and the U.S. Department of Health and Human Services, Office of Inspector General. The prosecution of the case has been handled by Assistant U.S. Attorneys Peter M. Jarosz and Kevin F. Burke.