A settlement has been reached for nearly $1.7 million to resolve civil claims against former physician Don J. Wagoner and his business, Wagoner Medical Center, L.L.C., according to an announcement from United States Attorney Adam L. Mildred.
The case stems from actions taken between 2011 and 2013, when Wagoner practiced medicine at his clinic in Burlington, Indiana. Court documents state that patients seeking opioid or other pain medication were required by the clinic to provide a urine sample for drug testing. The clinic used a multiplexed screening kit costing about ten dollars per test but billed Indiana Medicaid $171.27 or more per patient—despite Medicaid rules allowing only $20.83 per patient.
The complaint alleges that Wagoner and his business concealed their actions by falsely certifying that they had collected and analyzed nine or more urine samples from each patient, when only one sample was actually tested. This practice resulted in over 5,000 fraudulent claims and an overpayment of nearly $1 million from Indiana Medicaid.
On December 29, 2017, the United States and the State of Indiana filed a complaint under the False Claims Act seeking recovery of these funds as well as civil penalties. The settlement announced resolves this legal action.
Indiana Medicaid is a program designed to provide healthcare coverage for low-income residents who might not otherwise be able to afford medical care. It is funded jointly by federal and state governments. Laws such as the federal False Claims Act allow authorities to recover false claim amounts plus penalties; a portion of these recoveries supports future health care fraud investigations.
In connection with a separate state criminal investigation into his opioid-prescribing practices—which led to felony drug dealing convictions—Wagoner permanently surrendered his licenses to prescribe drugs and practice medicine in 2013.
United States Attorney Adam L. Mildred stated: “Although they no longer are endangering vulnerable Medicaid patients by practicing medicine, former physician Don Wagoner cannot be allowed to retain the fruits of his fraudulent Medicaid claims,” adding: “The U.S. Attorney’s Office will continue to make it a priority to pursue investigations and cases to recover funds that were fraudulently received from the Medicare and Medicaid programs.”
The litigation was led by Assistant United States Attorney Wayne T. Ault on behalf of the United States Attorney’s Office for the Northern District of Indiana in partnership with the Indiana Medicaid Fraud Control Unit within the Indiana Attorney General’s Office.
