2013 rePort - MultiBriefs · Between 1998 and 2008, Abbott promoted Depakote for the unapproved FDA...

M e d i c a i d F r a u d c o n t r o l u n i toFFice oF the attorney General oF VirGinia

ProtectinG VirGinia SeniorS and enSurinG Quality care

20132014

annualrePort

NationalAWARD FOREXCELLENCE � WINNER �

R2007 & 2013


R2007 & 2013

attorney General MarK r. herrinG

the Virginia Medicaid Fraud control unit’s 2013-2014 annual report

highlights achievements from the investigations and prosecutions

conducted by the unit. the men and women working in the Medicaid

Fraud control unit continue to surpass milestones in their fight to

protect Virginia’s seniors and ensure quality care.

Medicaid Fraud control unitoffice of the attorney General

900 East Main Street Richmond, VA 23219

(804) 786-2071

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taBle oF contentS

Letter from the Attorney General ............................................................................................ 2

Inspector General’s Award for Excellence in Fighting Fraud, Waste and Abuse .......................................................................................... 3

Preface ................................................................................................................................... 7

Statutory Authority ................................................................................................................. 8

Unit Mission ........................................................................................................................ 10

Office of the Attorney General Personnel ............................................................................. 11

Organizational Chart ............................................................................................................ 12

Significant Cases ................................................................................................................. 14

Criminal ............................................................................................................... 15

Detailed Case Summary – Criminal ..................................................................... 18

Civil ...................................................................................................................... 19

Detailed Case Summary – Civil ........................................................................... 21

Case Activity Summary ....................................................................................................... 22

Elder Abuse and Neglect Squad .......................................................................................... 23

Unit Projections ................................................................................................................... 24

Projections for 2014-2015 Fiscal Year By Category ........................................................... 25

Unit Performance ................................................................................................................. 26

Unit Activities ...................................................................................................................... 27

Memberships....................................................................................................................... 28

Newsletter ............................................................................................................................ 29

Access Updates from the MFCU ......................................................................................... 30

Annual Case Activity Summary - Fiscal Years 1982 through 2014 ..................................... 31

Number of MFCU Staff: Five-Year Average .......................................................... 32

Recovery Average for MFCU: Five-Year Average ................................................. 32

Recovery Average Per Number of Staff: Five-Year Average ................................................. 32

2013-2014 Expenditures ..................................................................................................... 33

Proposed 2014-2015 Budget .............................................................................................. 34

Training ................................................................................................................................ 35

Training Provided ................................................................................................. 36

Dates and Personnel Providing Training .............................................................. 38

Training Received ................................................................................................. 41

Dates and Personnel Attending Training .............................................................. 48

Kristine Asgian, Grants Manager

Esther Anderson, Administrative Manager

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June 30, 2014

To the citizens of the Commonwealth:

It is an honor to serve as the 48th Attorney General of the Commonwealth of Virginia and to share with you some of the exceptional work being done by my office’s Medicaid Fraud Control Unit (MFCU). Virginia’s MFCU enjoys a well-earned reputation as a national leader in investigating and prosecuting unscrupulous health care providers who commit fraud against Virginia’s Medicaid program and Virginia taxpayers. Whether it is billing for services not rendered, using improperly trained or uncertified employees, or abusing or neglecting patients, our talented team of investigators and prosecutors ends these abuses wherever they are found.

For more than thirty years, the Office of Attorney General’s MFCU has strengthened our Medicaid program and served the people of Virginia, particularly its vulnerable citizens who rely on Medicaid for needed medical services. What started as a six-person team in 1982 now includes more than 100 employees working in four regional offices, a Civil Unit, an Elder Abuse and Neglect Squad and an outreach component.

This year, as a result of our criminal and civil investigations, the Virginia MFCU has successfully recovered $61,702,764.48 in state and federal court-ordered restitution, fines and penalties from providers who defrauded, or attempted to defraud, the Medicaid program. This pushes the unit’s total criminal and civil recoveries to almost $2 billion over thirty years.

In 2013, MFCU broke its own record for the largest case ever investigated by a state agency for its $1.5 billion case against Abbott Labs for improperly marketing and promoting the prescription drug Depakote. Because of their exceptional work on state and national-level cases, MFCU won the 2013 Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse, an award presented annually to the nation’s top MFCU by the U.S. Department of Health and Human Services’ Office of the Inspector General. This was their second such award, having previously won in 2008 following the successful prosecution of the Purdue Frederick Company and three of its corporate officers. It was the largest such prosecution to date.

The MFCU’s outstanding performance is attributable to a focused team effort, exceptional working relationships with other state and federal agencies, and the selfless dedication of the men and women of the unit. These employees spend many days away from home and family to conduct surveillance, execute search warrants, analyze records, conduct interviews, and prosecute cases in court.

Despite the great work that has been done in the last year, we are not resting on our laurels. I recently asked the U.S. Department of Health and Human Services for funding to expand our staff, a move we believe will result in the recovery of millions of additional dollars in fraudulently obtained Medicaid funds.

We are also stepping up our efforts to prevent elder abuse and neglect, utilizing registered nurses to further investigate and prosecute cases in health care facilities and homes, and conducting more than 130 community outreach events on ways to prevent, recognize, and report elder abuse and neglect.

The following report reviews the second half of the 2012-2014 biennium, from July 1, 2013, to June 30, 2014, and sets forth the organization, operations, and accomplishments of the unit. I trust that you will find their work lives up to their reputation and the high standards of the Commonwealth of Virginia.

With kindest regards, I remain,

Mark R. Herring Attorney General of Virginia

COMMONWEALTH of VIRGINIAOffice of the Attorney GeneralMark R. Herring

Attorney General900 East Main Street

Richmond, Virginia 23219804-786-2071

FAX 804-786-1991

Protecting VirginiA SeniorS AnD enSUring QUALitY cAre

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Virginia WinsInspector General’s

aWard for

ExcEllEncEin Fighting Fraud, WastE, and abusEfIscal year 2013


R2007 & 2013


R2007 & 2013

this award was originally titled the Inspector General’s State Fraud Award, an OIG award for many years bestowed to a single MFCU that has made outstanding contributions in the fight against Medicaid fraud. The criteria for selection includes both the MFCU’s impact as measured in monetary recoveries and convictions, and also the use of innovative investigative and prosecutive techniques while successfully collaborating with the OIG Office of Investigations, State Medicaid agency, and other partners. In selecting a MFCU to receive this award, OEI consults closely with the headquarters and field offices of the OIG Office of Investigations.

In FY 2013, the Virginia MFCU maintained a highly effective collaboration with state, local and federal agencies. The Unit conducted joint investigations of fraud and patient abuse cases with the Virginia Department of Medical Assistance Services, the Offices of the United States Attorneys for the Eastern and Western Districts of Virginia, the Federal Bureau of Investigation, the Internal Revenue Service’s Criminal Investigation Division, the Food and Drug Administration (FDA), the Virginia Department of Health, the Virginia Department of Social Services, and the United States Department of Health and Human Services’ Office of Inspector General (OIG).

During FY 2013, the MFCU obtained 21 convictions and 11 civil settlements and judgments. The total recoveries related to these convictions and settlements were $1,008,988,074.68. The MFCU operated with a staff of approximately 96 employees.

The Office of Evaluation and Inspections (OEI) awarded the Virginia Medicaid Fraud Control Unit (MFCU) the Office of Inspector General’s (OIG) Award for Excellence in Fighting Fraud, Waste, and Abuse

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One noteworthy case, led by the MFCU and worked jointly with OIG, is the civil settlement agreement executed between Abbott Laboratories, Inc. and the Commonwealth of Virginia.

The global healthcare company, Abbott Laboratories, agreed to a settlement that resolved False Claims Act allegations that it improperly marketed and promoted the drug Depakote. Between 1998 and 2008, Abbott promoted Depakote for the unapproved FDA uses of aggression and agitation treatment in elderly dementia patients and for the treatment of schizophrenia. Abbott offered and paid illegal remuneration to induce health care professionals and pharmacies to prescribe Depakote. On October 2, 2012, Abbott was sentenced in the United States District Court for the Western District of Virginia, Abingdon, Division, on one count of Introduction of Misbranded Drugs into Interstate Commerce. Abbott was placed on 60 months of probation and ordered to pay fines, investigative costs, and asset forfeiture in an amount totaling $700,000,000.00. Abbott also settled its civil liability with an agreement to pay $800,000,000.00 for a total settlement of $1.5 billion. To date, this is the largest Medicaid fraud case investigated by a state in United States history.

The MFCU and OIG also worked together on an investigation of an ambulance company that was knowingly transporting ambulatory patients to dialysis appointments and falsifying the supporting documentation. An employee of the ambulance company pled guilty to conspiracy to commit health care fraud and received two years of probation. The owner of the company was convicted of conspiracy, health care fraud and making false statements relating to health care matters. The owner was sentenced to 48 months in prison. The investigation resulted in a $907,521.00 recovery to Medicare and private insurance programs. A Special Assistant United States Attorney from the Virginia MFCU assisted in prosecuting the defendants.

The MFCU Director, Randy Clouse, is a member of the National Association of Medicaid Fraud Control Units’ (NAMFCU) Performance Standards and Finance Committees. The Unit Director is also Chairman of the Virginia Department of Health Professions Prescription Drug Monitoring Board.

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“ Our criteria for selection includes both the MFcu’s impact as measured in monetary recoveries and convictions, and also the use of innovative investigative and prosecutive techniques while successfully collaborating with the Oig Office of investigations, state Medicaid agency, and other partners.”

The Office of Evaluation and Inspections awarded the Virginia Medicaid Fraud Control Unit the Office of Inspector General Award for Excellence in Fighting Fraud, Waste, and Abuse during a ceremony in Washington, DC on June 17th.

The Virginia Medicaid Fraud Control Unit won the Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse, an award presented annually to the nation’s top MFCU by the U.S. Department of Health Office of the Inspector General (OIG). The award was presented to Virginia MFCU Director Randy Clouse on June 17, 2014 during a ceremony at the U.S. Department of Health and Human Services in Washington.

(Pictured, l-r): Steve Buck, MFCU Chief Section Counsel; Richard Stern, OIG Director, Medicaid Fraud Policy and Oversight Division; Gary Cantrell, OIG Deputy Inspector General for Investigations; Gloria Jarmon, OIG Deputy Inspector General for Audit Services; Clay Garrett, Chief of Civil Litigation; John Peirce, MFCU Investigative Supervisor; Randy Clouse, MFCU Director and Chief; Gregory Demske, OIG Chief Counsel to the Inspector General; Brian Ritchie, OIG Acting Deputy Inspector General for Evaluation and Inspections; Daniel Levinson, OIG Inspector General; Doug Johnson, MFCU Deputy Director of Investigations and Audits; Linda Bryant, VA Deputy Attorney General; Paul Johnson, OIG Deputy Inspector General for Management and Policy; Giovanna (Joanne) Chiedi, OIG Deputy Principal Inspector General.

Report from OIG on nomination for Inspector General’s Award for excellence in fighting fraud, waste and abuse.

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PreFace

The Virginia Medicaid Fraud Control Unit (MFCU or the Unit) of the Office of the Attorney General was certified October 1, 1982, by the United States Department of Health and Human Services. The Unit is one of 50 similarly structured Units throughout the United States. In deciding to establish a MFCU in Virginia, the General Assembly stated:

“ the General assembly finds and declares it to be in the public interest and for the protection of the

health and welfare of the residents of the commonwealth that a proper regulatory and inspection

program be instituted in connection with the providing of medical, dental and other health services to

recipients of medical assistance. in order to effectively accomplish such purpose and to assure that the

recipient receives such services as are paid for by the commonwealth, the acceptance by the recipient

of such services and the acceptance by practitioners of reimbursement for performing such services

shall authorize the attorney General or his authorized representative to inspect and audit all records in

connection with the providing of such services.”

Section 32.1-310, Code of Virginia, 1950, as amended.

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In 1981, the Virginia General Assembly enacted Chapter 9, §§ 32.1-310 through 32.1-321 of the Code of Virginia to regulate medical assistance in the Commonwealth. This chapter authorizes criminal sanctions for specific acts of Medicaid fraud and abuse. The duties and responsibilities of the Unit are set forth in § 32.1-320.

In 1982, the Unit was established within the Office of the Attorney General in accordance with federal requirements. This Unit is separate and distinct from the Department of Medical Assistance Services (DMAS), which is the single state agency in the executive branch responsible for the administration of the Medicaid program.

In 1995, the General Assembly significantly amended the Medicaid fraud statutes by converting Virginia Code § 32.1-314, the most frequently charged crime under the Medicaid fraud statutes, from a larceny-type offense to a false-claims offense. The change eliminated the requirement that the Commonwealth prove $200 or more was wrongfully taken from the program in order to secure a felony conviction. Under the amended statute, the Commonwealth need only prove that a materially false statement was made in an application for reimbursement under the program.

In 2007, the General Assembly enacted a number of changes to health care fraud statutes in Virginia to ensure compliance with the federal Deficit Reduction Act of 2005. (2007 Va. Acts cc. 562,653). Before the 2007 amendment, abuse of an incapacitated adult resulting in serious bodily injury or disease was a Class 4 felony punishable by a term of imprisonment of not less than two years nor more than 10 years and a fine of not more than $100,000.

In 2007, the General Assembly enacted a number of changes to health care fraud statutes in Virginia to ensure compliance with the federal Deficit Reduction Act of 2005.

• Amended Virginia Code § 8.01-216.3 to increase the minimum penalty from $5,000 to $5,500 and increase the maximum penalty from $10,000 to $11,000;

• Amended Virginia Code § 8.01-216.3 to allow the Virginia Attorney General’s Office to recover attorney fees and costs incurred in its investigation and prosecution of qui tam, or whistleblower, actions;

• Amended Virginia Code §§ 8.01-216.5 and 8.01-216.6 to replace “motion for judgment” and “motion” with “complaint” (lines 55, 56-57, 59, 62, 64,77, 78);

• Amended Virginia Code § 8.01-216.9 to (1) extend the statute of limitations period; (2) extend the burden of proof requirement; and (3) prevent defendants from denying civil liability if they are convicted in a criminal proceeding based on the same transaction or occurrence; and

• Amended Virginia Code §§ 32.1-312 and 32.1-313 to extend the statute of limitations and allow Virginia to bring a civil action for fraud against health care subcontractors that provide services or goods to Medicaid recipients, but do not contract directly with Virginia’s state provider (DMAS) pursuant to a provider agreement.

Statutory authority

Lee Cheeseman, MFCU Computer Forensic and IT Supervisor

Linda Bryant, Deputy Attorney General for the Public Safety and Enforcement Division

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In addition, the United States Department of Health and Human Services, Office of the Inspector General, issued a ruling on March 13, 2007, that found Virginia’s statutory regime was in compliance.

In 2012-2013, the General Assembly amended § 32.1-320 of the Code of Virginia to expedite health care fraud investigations and litigation. The revisions clarify existing authority for the Medicaid Fraud Control Unit to subpoena health records under the Health Privacy Act. Further, the amendments codified protections for attorney work product and privileged investigative files developed in the course of MFCU investigations and litigation. The codification provides a statutory basis to assert protection for such materials during the course of litigation. As many qui tams are filed in jurisdictions outside of Virginia, this change provides additional protections of attorney work product and investigative materials in matters filed in jurisdictions with differing practices and case law as to the extent of such privileges.

MFcu Senior ManaGeMent teaM

StandinG, leFt to riGht:Eric Atkinson, Chief of Elder Abuse; Steve Buck, Chief Section Counsel; Clay Garrett, Chief of Civil Litigation; David Tooker, Chief Prosecutor; Doug Johnson, Deputy Director of Investigations and Audits

Seated, leFt to riGht:Erica Bailey, Chief of eDiscovery and Litigation Support; Esther Welch Anderson, Administrative Manager; Randy Clouse, Director and Chief; Jill Costen, Chief Investigator for Provider Fraud; Peggy Horn, Chief of Multi-State Investigations

Randy Clouse, MFCU Director and Chief

Cynthia Hudson, Chief Deputy Attorney General

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the unit is charged with the investigation and prosecution of Medicaid

providers who conduct their businesses in a fraudulent or highly abusive

manner. the intended result of this effort is to deter all providers of medical

services from engaging in fraudulent or abusive behavior.

In order to achieve this goal, the Unit will:

• Conduct professional and timely criminal investigations that lead to just results;

• Collaborate with other state and federal agencies involved in the battle against healthcare fraud and patient abuse and neglect throughout the Commonwealth. In fact, the MFCU is uniquely positioned to take the lead in investigating and prosecuting healthcare fraud and patient abuse and neglect in the Commonwealth;

• Seek alternatives to criminal prosecution, such as provider education when appropriate, to reinforce and instill in the provider community a desire to comply with all regulations promulgated by DMAS;

• Provide educational resources to the community, law enforcement, and other agencies through presentations on the work of the MFCU, and the publishing of newsletters and brochures which provide information on Medicaid fraud as well as elder and patient abuse and neglect;

• Refine internal operating procedures designed to produce timely investigative results and maximize Unit resources in order to promote efficient and thorough strategies for each case;

• Promote effective communication between the Unit and DMAS, thereby increasing the number and quality of referrals;

• Maintain the highest standards of excellence through aggressive training on current fraud trends and law enforcement tools in an attempt to better combat fraud in the Medicaid program; and

• Provide assistance related to nationwide civil and criminal healthcare fraud matters.

unit MiSSion

Patricia Lewis, Unit Program Coordinator

Debra Kilpatrick, Administrative Coordinator

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oFFice oF the attorney General PerSonnel

the honorable Mark r. herring Attorney General

the honorable cynthia e. hudson Chief Deputy Attorney General

linda lee Bryant Deputy Attorney General Public Safety and Enforcement Division

randall l. clouse Director and Chief Health Care Fraud and Elder Abuse Section

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June 30, 2014

VIRGINIA OFFICE OF THE ATTORNEY GENERAL

MEDICAID FRAUD CONTROL UNIT

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SiGniFicant caSeS

the following are brief summaries of significant cases that resulted in the successful convictions of numerous fraudulent healthcare providers in the commonwealth during fiscal year 2013-2014.

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conSuMer directed ProGraM Fraud

The defendant worked as a personal care attendant providing care to a Medicaid recipient under the Elderly and Disabled Consumer Directed Program providing care to her mother who was a Medicaid recipient. The defendant submitted fraudulent time sheets claiming to have worked while she was being held in the Roanoke City Jail. The defendant also submitted a fraudulent time sheet for a time period when the recipient was in the hospital. The defendant admitted that she had billed Medicaid for 429.5 hours that she had not worked. On January 14, 2014, in the Circuit Court in Roanoke, Virginia, defendant pled guilty to two counts of Medicaid fraud and one count of obtaining money by false pretenses. On the Medicaid fraud counts, she was sentenced to a total of two years in a state correctional facility, with two years suspended for a period of three years, with three years supervised probation. The defendant was excluded from billing Medicaid or any other federal healthcare program for ten years. She was ordered to pay restitution in the amount of $3,805.37 to Virginia Medicaid. She was sentenced to one year in a state correctional facility with one year suspended, with one year of supervised probation on the obtaining money by false pretenses count.


The defendant was providing attendant care to a Medicaid recipient under a consumer directed waiver program. She billed Medicaid for hours that she had not worked. On February 18, 2014, in Circuit Court in Washington County, Virginia, defendant pled guilty to one count of Medicaid Fraud. She was sentenced to five years, suspended on three years of active supervised probation. She was also ordered to pay restitution to Virginia Medicaid in the amount of $6,123.75.


The defendant served as the service facilitator for a Medicaid recipient under a consumer directed waiver program. The investigation showed that defendant was falsely billing Medicaid, and being paid for services that were not rendered to the recipient. The previous facilitator suspected that aides were billing for personal care attendant services that were not being performed. The defendant, a Registered Nurse, made an initial assessment of the recipient and established a plan of care that approved personal care services. Thereafter, the defendant billed Medicaid for assessments and training that she did not perform or conduct. On March 11, 2014, in United States District Court for the Western District of Virginia, the defendant was sentenced on one count of making false statements in relation to healthcare matters, and one count of healthcare fraud. She was sentenced to 24 months probation and ordered to pay restitution to Virginia Medicaid in the amount of $550.21.

tranSPortation Fraud

On September 20, 2012, in the United States District Court for the Western District of Virginia, following a two-week trial, a jury convicted the defendant of conspiracy to commit health care fraud, health care fraud, false statements relating to health care matters, and making false material declarations to a grand jury. The transportation company was acquitted of all charges. The transportation company provided transportation services and billed federal and private insurance companies for the service. Non-ambulatory (bed-confined) transportation is billed and

criMinal caSeS

Lera Champagne-Andriani, Nurse Investigator

Eric Atkinson, Chief of Elder Abuse and Adele Neiburg, Assistant Attorney General

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criMinal caSeS CONTINUED

reimbursed at a higher rate than ambulatory transportation service. The defendant was the business manager. The defendant directed the falsification of trip sheets to indicate that the patients transported were non-ambulatory and billed insurers at the higher rate. Certificates of medical necessity were falsified by a co-conspirator to create a paper trail to justify billing at the higher rate. Over $2.6 million in false claims and were submitted.

On March 21, 2013, the defendant was sentenced to 48 months in prison. In addition to his sentencing, the court imposed a monetary judgment for $907,521, the full amount of the fraud. The court also forfeited defendant’s assets, including bank accounts, vehicles, real estate, and an ambulance service, in partial satisfaction of the money judgment.

The defendant filed an appeal challenging the sufficiency of the evidence, inconsistent verdicts, abuse of discretion by the sentencing court, and the erroneous imposition of a forfeiture. On March 18, 2014, in the Fourth U.S. Circuit Court of Appeals, oral arguments were presented by a MFCU attorney. On June 23, 2014, the Fourth Circuit unanimously affirmed the lower court’s rulings on all issues.


In the Circuit Court in the City of Richmond, two defendants were indicted on obtaining money by false pretenses, Medicaid fraud, conspiracy to obtain money by false pretenses, and conspiracy to commit Medicaid fraud. The son of defendant 1 was approved to receive Medicaid services through a consumer directed waiver program. Defendant 1, as the employer of record, hired her boyfriend, defendant 2, to provide attendant care to her son for 47 hours per week. The Medicaid recipient’s case manager reported that the recipient was not receiving care. The recipient attended a weekend respite program one weekend a month. Attendance records established defendants submitted times sheets for the weekends when the recipient was away from the home entirely. In addition, the recipient lived with a family friend before transitioning to living at a residential facility. During this period, defendants submitted timesheets claiming care was being provided. Defendants admitted to submitting false billings because defendant 1 was struggling financially.

On January 9, 2014, defendant 1 pled guilty to one count of Medicaid Fraud. She was sentenced to five years in a state correctional facility, with five years suspended for a period of ten years, and five years of supervised probation. She was ordered to pay restitution in the amount of $22,460.38 to DMAS. As part of the plea agreement, defendant 1 agreed to be excluded from billing Medicaid or any other federal healthcare program for ten years.

On April 16, 2014, defendant 2 pled guilty to one count of Medicaid Fraud. He was sentenced to five years in a state correctional facility, with five years suspended for a period of five years, and five years of supervised probation. He was ordered to pay restitution in the amount of $22,460.38 to DMAS. As part of the plea agreement, Defendant 2 agreed to be excluded from billing Medicaid or any other federal healthcare program for ten years.

Nicolette Stumpf, Legal Secretary

Jason Martin, Computer Forensic Specialist

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neGlect reSultinG in death

The defendant owned and operated a group home for intellectually disabled Medicaid recipients. On February 8, 2011, one of the residents experienced an unfortunate episode of incontinence at the group home and was placed on a toilet by the caretakers. While they proceeded to clean the affected area of the house, the resident was injured in a bathtub under a running faucet or shower head of scalding water. The resident was found partially submerged and burned on his legs and back. The defendant decided the resident would be treated at the group home and not taken to the hospital. The defendant told staff to apply Neosporin to the resident’s wounds and failed to report the incident to a state licensing agency within 24 hours, as required, and later minimized the condition in making a report. The resident was found dead on February 18, 2011. A pathologist described second and third-degree burns on 30 percent of his body. The cause of death was sepsis and pneumonia secondary to burns.

On May 4, 2012, the defendant was convicted of neglect of an incapacitated adult resulting in death. On October 18, 2012 the defendant was sentenced in state court to five year’s incarceration with all five years suspended for a period of ten years and one year of supervised probation.

The defendant appealed his conviction to the Virginia Court of Appeals arguing (1) that the trial court applied the wrong decisional standard in denying his motion to set aside the jury verdict; (2) that the evidence was insufficient to support a finding that his conduct was a proximate cause of the victim’s death; and (3) that the evidence was insufficient to establish that he committed a willful act with knowledge and consciousness that injury or death would result to the victim. On April 8, 2014, the Virginia Court of Appeals rejected each of the defendant’s assignments of error and affirmed the ruling of the trial court.

Mental health ProVider Fraud

The defendant owned and operated a Medicaid company that provided intensive in home therapy (IIH) and mental health support (MHS) services. Medicaid, through a third party contractor, relies on the prior-authorizations providers prepare and submit requesting approval to bill for IIH and MHS services. Prior-authorizations explain why each recipient is in need of either IIH or MHS services. The defendant submitted and caused to be submitted false and fraudulent prior-authorizations representing eligibility criteria and factors that had been embellished, exaggerated, or wholly invented to satisfy Medicaid’s eligibility standards for IIH and MHS services. The defendant’s scheme to defraud resulted in Medicaid paying the company $1,505,173.00 to which it was not entitled. On September 30, 2013, in United States District Court for the Eastern District of Virginia, Norfolk Division, the defendant pled guilty to a criminal information charging one count of health care fraud. On May 30, 2014, the defendant was sentenced to 15 months incarceration, six months home confinement, three years supervised release, $25,000 fine, $100 special assessment and $1,505,173.00 in restitution to the Department of Medical Assistance Services. In addition, the defendant also forfeited $1,505,173.00 to the United States Department of Justice.

Attorney General Herring speaking to senior citizens in Hanover

Eda Montgomery, Investigative Supervisor

18

detailed caSe SuMMary – criMinal

CARRIED OVER OPENED CLOSED PENDING

INSTITUTIONSNursing Homes 1 0 0 1

Hospitals 0 0 0 0Other 0 0 0 0

PRACTITIONERSMD/OD 4 1 2 3Dentists 0 0 0 0Podiatrists 0 1 0 1Psychiatrist/Psychologist 4 4 3 5Other 2 1 2 1

MEDICAL SUPPORTPharmacy 0 1 0 1Durable Medical Equipment 0 0 0 0Laboratories 0 0 0 0Medical Transportation 1 0 0 1Home Health Agencies 5 3 2 6Home Health Aide (HHA) 31 40 26 45Rehabilitation Therapists 0 0 0 0Other 3 4 1 6

PATIENT ABUSE AND NEGLECTPatient Abuse 10 9 3 16Corporate Neglect 0 0 0 0

PATIENT FUNDSPatient Funds 0 0 0 0

TOTAL 61 64 39 86

July 1, 2013 - June 30, 2014

19

Violation oF anti-KicKBacK Statute

In one settlement, the United States and five states (VA, CA, IN, KY, and MA) intervened in two qui tam actions against a pharmaceutical manufacturer filed in the United States District Court for the District of Massachusetts. The federal and state complaints were based upon allegations of kickbacks paid by the pharmaceutical company to a long-term care pharmacy provider resulting in false claims for reimbursement submitted to government healthcare programs, including Medicaid. The government plaintiffs alleged that the kickbacks were intended to induce the long term care pharmacy provider to switch nursing home patients to the pharmaceutical company’s prescription drug products.

These cases were aggressively litigated by the Department of Justice and the five plaintiff states, including the Commonwealth of Virginia, until negotiations ultimately resulted in settlement. The total settlement for the government, including the United States and five plaintiff states, was $149 million. Virginia received approximately $3,574,970.55 as part of a larger settlement negotiated with the pharmaceutical manufacturer over allegations that the company violated the Virginia Fraud Against Taxpayers Act. The Commonwealth of Virginia’s General Fund Health Care Account received $1,775,497.55 as the state Medicaid share of this settlement.

MarKetinG oF an unaPProVed druG

Moreover, the Commonwealth of Virginia joined with other states and the federal government in a global settlement with a pharmaceutical manufacturer and its subsidiary to resolve civil and criminal allegations of unlawful marketing practices to promote the sales of their atypical antipsychotic drugs products. Under the terms of the civil settlement, the companies paid over $1.2 billion to the states and the federal government. The settlement resolved four qui tam, (a/k/a whistleblower) lawsuits filed in the United States District Court for the Eastern District of Pennsylvania, under the provisions of the federal False Claims Act and similar state False Claims statutes. In addition, the pharmaceutical manufacturer pled guilty in federal court to a criminal misdemeanor charge of misbranding in violation of the Food, Drug, and Cosmetic Act. As part of the criminal plea, the company agreed to pay an additional $400 million in criminal fines and forfeitures.

As part of the global resolution, the companies entered into a Corporate Integrity Agreement with HHS-OIG which will require close monitoring of future marketing practices. A team from the National Association of Medicaid Fraud Control Units worked closely with the federal government on the investigation and conducted the settlement negotiations with the pharmaceutical manufacturers on behalf of the states. Virginia received approximately $17,445,682 as part of this settlement. The settlement returned approximately $8,105,539 to the Commonwealth of Virginia’s General Fund Health Care Account as the state Medicaid share of this settlement.

ciVil caSeS

Kevin Boone, eDiscovery Analyst

Heather Blanchard, eDiscovery Project Manager

20

ciVil caSeS CONTINUED

Fraudulent druG PricinG

Finally, in another significant case, the Commonwealth of Virginia recovered $37 million in a health care fraud settlement with one of the largest pharmaceutical wholesalers in the country over allegations the company violated the Virginia Fraud Against Taxpayers Act by conspiring to inflate prices for more than 400 brand-named prescription drugs. As a result of the settlement, the Attorney General’s Office returned approximately $30 million to the Commonwealth of Virginia’s General Fund Health Care Account.

In June 2011, the MFCU worked with outside counsel to file a civil action in the United States District Court for the Northern District of California. The October 2013 settlement resolved allegations that the pharmaceutical wholesaler caused false or fraudulent claims for payment to be submitted to Virginia’s Medicaid Program by conspiring with a corporation to fraudulently inflate the Average Wholesale Price (AWP) of many brand name prescription drugs. AWP is the pricing benchmark used by DMAS for brand-name drug reimbursement transactions. During the time period covered by this settlement, AWPs were compiled and publicly made available by a pharmaceutical information publisher. Beginning in late 2001, the pharmaceutical wholesaler and the pharmaceutical information publisher engaged in a scheme to inflate the AWP-WAC spread on the cost of over 400 brand-name drugs, and caused the Virginia Medicaid program to overpay on those drugs by about 4% through September 2009.

The settlement reflected three years of active litigation against the corporation by the Medicaid Fraud Control Unit civil attorneys and multiple years of investigation. By filing in the Northern District of California, Virginia was able to conduct the litigation before a court that had previously dealt with similar allegations related to the fraudulent scheme and expeditiously litigate the matter to a successful conclusion.

Steve Buck, Chief Section Counsel

Civil Unit staff meeting

Tracey Sanders, Assistant Attorney General

21

detailed caSe SuMMary - ciVil

CARRIED OVER OPENED CLOSED PENDING

INSTITUTIONSNursing Homes 3 3 0 6

Hospitals 7 3 2 8Other 9 4 5 8SUBTOTAL — — — —

PRACTITIONERSMD/OD 2 2 2 2Dentists 5 2 0 7Podiatrists 0 0 0 0Psychiatrist/Psychologist 0 0 0 0Other 0 1 0 1SUBTOTAL — — — —

MEDICAL SUPPORTPharmacy 38 12 10 40Durable Medical Equipment 49 22 28 43Laboratories 16 6 6 16Pharmaceutical Companies 199 41 79 161Medical Transportation 1 0 1 0Home Health Agencies 5 2 3 4Rehabilitation Therapists 0 0 0 0Other 7 0 2 5Managed Care Providers 6 6 1 11

PATIENT ABUSE AND NEGLECTCorporate Neglect 0 0 0 0SUBTOTAL 0 0 0 0

TOTAL 347 104 139 312

July 1, 2013 - June 30, 2014

22

caSe actiVity SuMMary

CASELOADCASES CARRIED OVER

(7/1/2013) 408

Cases opened Criminal 64

Civil 104

TOTAL 168Cases Closed With criminal resolution 27

With civil resolution 22Insufficient evidence/no further action 129

TOTAL 576Indicted cases pending court action 30

TOTAL CASES PENDING (7/1/2014) 398CRIMINAL PROSECUTION/RECOVERY

Indictments 47Convictions 31Dismissed/NP 3Acquittals 1Total length of probation 1884Total incarceration time 1701Total suspended incarceration time 1605Total hours of community service 65Providers terminated from program upon conviction 31

CRIMINAL RECOVERY Ordered restitutions, reimbursements, criminal fines and interest, asset forfeiture, monetary penalties

$1,705,029.76

Actual Cash Recoveries $(48,852,545.37)

CIVIL RECOVERY - INCLUDING AFFIRMATIVE CIVIL ENFORCEMENT (ACE)Settlement/Reimbursements received $59,997,734.72Investigative costs received —

TOTAL $61,702,764.48

23

the elder abuse and neglect Squad of the MFcu investigates allegations of abuse or neglect of elderly and incapacitated adults receiving Medicaid benefits in the commonwealth. as a result of a widespread networking effort including adult Protective Services, local ombudsmen, law enforcement, and commonwealth’s attorneys, collegial relationships have developed and referrals are arriving at a fast pace. the elder abuse and neglect Squad strives to provide rapid response to referrals, effective investigations, and successful outcomes so that Virginia’s vulnerable adults receive the highest quality of care possible in both home and institutional settings.

elder aBuSe and neGlect SQuad

24

unit ProJectionS

The MFCU has an outstanding working relationship with state, local and federal agencies. Some of the key partner agencies are the Virginia Department of Medical Assistance Services, the Offices of the United States Attorney for the Eastern and Western Districts of Virginia, the Federal Bureau of Investigation, the United States Department of Health and Human Services’ Office of Inspector General, the Internal Revenue Service’s Criminal Investigation Division, the Virginia Department of Health, the Virginia Department of Social Services, and local law enforcement. Attorney General Herring’s approach to the investigation of major fraud cases, in conjunction with other state, local and federal agencies, contributed to the positive results obtained by the Unit last year.

At the end of the 2013-2014 reporting year, the Unit had 398 active criminal and civil investigations of healthcare providers located throughout the Commonwealth. In addition, 47 people have been indicted and 25 individuals are awaiting trial or sentencing in federal court. The Civil Investigations Squad has opened 104 new civil cases.

The Unit will continue to participate in joint federal and state task forces to investigate and develop complex cases dealing with provider fraud in the fee-for-service community and the institutional neglect cases of patients in nursing homes. The Unit will also continue to work closely with the Offices of the United States Attorney for the Eastern and Western Districts of Virginia to pursue Medicaid providers through the Federal False Claims Act and the Virginia Fraud Against Taxpayers Act. During state fiscal year 2014-2015, the Unit projects that the investigative, prosecutive, and civil recovery efforts of the Unit will result in 20 convictions, with combined criminal and civil recoveries of more than $30 million.

Vaso Doubles, Assistant Attorney General/Prosecutor

Candice Deisher, Lead Attorney/Assistant Attorney General

25

ProJectionS For 2014-2015 FiScal year

CATEGORY PROJECTIONSINSTITUTIONSNursing Homes 6Home Health Agencies (HOM) 5Hospitals 5Other Institutions 0PRACTITIONERSDentists 2Physician 6Podiatrists 1Psychiatrist/Psychologist 6Other (Licensed Social Worker, Mental Home Health Social Worker) 6MEDICAL SUPPORTDurable Medical Equipment 22Home Health Aide (HHA) 50Laboratories (LAB) 10Medical Transportation (TRA) 0Pharmacy (PHA) 15Pharmaceutical Manufacturers (PHM) 65Rehabilitation Therapists (REH) 5Managed Care Provider 4Others Medical Support 5PATIENT ABUSE & NEGLECTPatient Abuse (CNA , RN, LPN, MD) 8Corporate Neglect (NUR, HOM, HOS) 6PATIENT FUNDSPatient Funds 5TOTAL PROJECTIONS 232Projected Criminal & Civil Recoveries $30,000,000.00Projected Criminal Convictions & Civil Settlement/Judgments 20

26

unit PerForMance

In 1982, the United States Department of Health and Human Services certified the Virginia MFCU as the nation’s 31st Medicaid Fraud Control Unit. Over the past 31 years, the Virginia MFCU has been responsible for the successful prosecution of more than 299 providers in cases that involved patient abuse and neglect or the commission of fraudulent acts against the Virginia Medicaid program. In addition to prosecuting those responsible for healthcare fraud and/or abuse, the Unit has recoveries of $1,908,637,177.57 in criminal restitution, fines and penalties, asset forfeiture, civil judgments, and settlements.

The Medicaid Fraud Control Unit was very successful in fiscal year 2013-2014, particularly through its participation in multi-agency investigations. The Unit ended the fiscal year with 31 convictions and total court ordered recoveries from criminal and civil investigations of $61,702,764.48.

ediScoVery teaM

Sara Skeens, eDiscovery Supervisor, Mike Hnatowski, eDiscovery Project Manager, Heather Blanchard, eDiscovery Project Manager, Kevin Boone, eDiscovery Analyst

27

Social Security taSK Force

The MFCU continues to participate in a pilot project with the Social Security Administration that investigates allegations of disability fraud involving the Social Security and Medicaid programs. This program began in 2003 and has been successful in its ongoing mission. The Social Security Administration pays all costs incurred by the MFCU, including salaries, benefits, and investigative costs. By preventing unqualified persons from receiving Social Security disability benefits, the Task Force prevents the expenditure of unwarranted Medicaid funds. The Task Force finished the year with a savings to the Virginia Medicaid program of $10,853,987.00 and a savings to the Social Security program of $14,342,941.00 for a total savings of $25,196,928.00.

coMMunity outreach initiatiVe

By expanding outreach efforts to seniors, law enforcement and senior citizen service providers, Virginia’s Medicaid Fraud Control Unit is helping to inform the community about the latest methods to effectively prevent and/or report elder abuse and provide an additional resource for investigative referrals as well as how to recognize and report Medicaid fraud. MFCU’s Community Outreach Coordinators are establishing and strengthening programmatic partnerships between MFCU and community organizations, government agencies, academic institutions and law enforcement personnel working with Virginia’s senior population.

The Medicaid Fraud Control Unit has two full-time community outreach workers who visit community groups and educate them on how to report and recognize signs of elder abuse. One outreach worker is assigned to the eastern half of Virginia and one is assigned to the western half. During the last fiscal year, MFCU’s outreach workers traveled more than 14,000 miles, speaking to more than 18,000 citizens, informing them about the problem of elder abuse and neglect and the need for them to report cases of abuse to our Unit for investigation and possible prosecution.

unit actiVitieS

Kristen Gray, Assistant Attorney General

ediScoVery teaM

Sara Skeens, eDiscovery Supervisor, Mike Hnatowski, eDiscovery Project Manager, Heather Blanchard, eDiscovery Project Manager, Kevin Boone, eDiscovery Analyst

Elizabeth Fitzgerald, Assistant Attorney General

28

MeMBerShiPS

The MFCU Director and Chief has continued to serve on the Department of Health Professions Prescription Drug Monitoring Board and this year was elected Chairman. The MFCU Director and Chief is also a member of the National Association of Medicaid Fraud Control Unit’s (NAMFCU’s) Performance Standards Working and Finance Committees.

MFCU staff also belong to other organizations including:

Joseph Hall, Assistant Attorney General

American Association of Legal Nurse Consultants

American Bar Association

American Health Lawyers Association

Association of Certified Anti-Money Laundering

Association of Certified Fraud Examiners

Association of Government Accountants

Board of the Society of Government Meeting Professionals

Colorado State Bar

Department of Professional Occupational Regulation

High Tech Crime Consortium

International Association of Special Investigation Units

International Association of Computer Investigative Specialists

NAGRI E-Discovery Working Group

NAMFCU Global Intake Team

NAMFCU Managed Care Working Group

New York State Bar Association

Richmond ACAMS Chapter

Richmond CFE Chapter

The Sedona Conference

The Institute of Internal Auditors

United States District Court for the Eastern District of Virginia

United States District Court for the Western District of Virginia

Virginia Board of Accountancy

Virginia Coalition for the Prevention of Elder Abuse

Virginia Local Government Auditors

Virginia Polygraph Association

Virginia State Bar

Women in eDiscovery – Richmond Chapter Member

Steve Grist, Assistant Attorney General/Prosecutor

29

The MFCU publishes quarterly newsletters which provide information on important cases, meetings across the Commonwealth, feedback from different jurisdictions, tips, and contact numbers. Sign up to be placed on our distribution list by e-mailing your request to [email protected]. You may also view this and other editions of the MFCU Newsletter at http://tiny.url.com/VAMFCU.

newSletter

1

INSIDE THIS ISSUE:

CASE: ELDER ABUSE AND NEGLECT CASE

1

THE COMMONWEALTH FROM CORNER TO CORNER

2

WHAT IF YOU SUSPECT FRAUD BY A MEDICAID RECIPIENT

3

ORDER MATERIALS FOR YOUR COMMUNITY

4

CONTACT INFORMATION 4-5

WANT TO BE PLACED ON OUR DISTRIBUTION LIST?

5

If you suspect that Medicaid fraud or elder abuse and neglect has occurred in a Medicaid facility or has been committed by someone working for a Medicaid provider, immedi ately contact Adult Protective Services and your law enforce ment office. Then, report the incident to the Medicaid Fraud Control Unit (MFCU) of the Office of the Virginia Attorney General at 1-800-371-0824 or 1-804-371-0779

June 2014

VOLUME 5, ISSUE 2

This case was referred to the MFCU from the Martinsville Police Department. The victim, was a 57 year old adult suffering from Parkinson's disease and other disorders who was receiving care in a group home operated by the Claye Corporation. On February 8, 2011, the victim experienced an episode of incontinence at the group home. While his caretakers proceeded to clean the affected area of the house, the victim was severely burned by scalding water from a running faucet or shower head. The victim was found partially submerged and severely burned on his legs, back, face and arm. The victim’s caregivers placed him in a van intending to transport the vic-tim to the hospital. Before the victim could arrive at the hospital, Richard Wagoner (owner of Claye Corporation) ordered the van to turn around and return the victim to the group home, and that the victim be treated for his injuries there. Ten days later, the victim died from complications resulting from lack of proper medical treatment for his severe burns.

Case Outcome On May 4, 2012, Wagoner was convicted of Neglect of an Incapacitated Adult Re-sulting in Death in violation of Va. Code §18.2-369. On October 18, 2012 Richard Wagoner was sentenced in Martinsville Circuit Court to five years incarceration with all five years suspended for a period of ten years and one year of supervised proba-tion.

Appeal On April 8, 2014, the Court of Appeals of Virginia (CAV) issued an opinion affirm-ing Wagoner's convictions. On appeal Wagoner asserted (1) that the trial court ap-plied the wrong decisional standard in denying his motion to set aside the jury ver-dict; (2) that the evidence was insufficient to support a finding that his conduct was a proximate cause of the victim’s death; and (3) that the evidence was insufficient to establish that he committed a willful act with knowledge and consciousness that in-jury or death would result to the victim. The CAV rejected these claims holding that the trial court properly applied the law and the evidence in convicting Wagoner. On May 8, 2014, the CAV denied Wagoner's petition for Rehearing En Banc.

Virginia Attorney General’s Office Medicaid Fraud Control Unit

ELDER ABUSE AND NEGLECT CASE

Megan Holt, Assistant Attorney General

Mike Hnatowski, eDiscovery Project Manager

30

acceSS uPdateS

VirGinia MFcu FaceBooK PaGe

www.facebook.com/VaMFcu

Facebook is a social networking service and website with more than one billion active users, primarily through Facebook profiles. Facebook pages are used by organizations and businesses to broadcast information in an official, public manner to people who choose to connect with them.

The Virginia Medicaid Fraud Control Unit’s Facebook page can be accessed at: http://www.facebook.com/VAMFCU. Visit the site often, and remember to click on the “Like” button to receive updates.

In addition to up-to-the-minute news on MFCU activities on the “wall,” the page features links to basic information about MFCU, a calendar of upcoming MFCU outreach presentations, photos from MFCU events, MFCU-related videos, and links to brochures, news releases, quarterly newsletters, annual reports, etc.

the Virginia attorney General’s office has tools to promote the accomplishments of the men and women working in

the Medicaid Fraud unit and to keep its citizens informed.

VirGinia MFcu PintereSt account

www.pinterest.com/VaMFcu

Virginia MFCU posts items of interest on Pinterest, a popular content sharing service that allows users to “pin” items on a virtual “pinboard.” Visitors to www.pinterest.com/VAMFCU can now see recent news articles on Medicaid fraud and elder abuse, photos, videos and reports about community outreach.

VirGinia MFcu twitter account

www.twitter.com/VaMFcu

Twitter is a real-time information network that connects users to the latest stories, ideas, opinions and news about what they find interesting. Virginia MFCU now has its own Twitter account, which sends brief updates on our fight against Medicaid fraud and elder abuse to all who choose to follow by logging in at www.twitter.com/VaMFCU.

31

annual caSe actiVity SuMMary

FiScal yearS 1982 throuGh 2014

total criminal and civil recoveries, including affirmative civil enforcement cases

(ordered and collected reimbursements, fines, restitutions)

FISCAL YEAR TOTAL RECOVERIESJuly 82 - June 83 $5,600.00

July 83 - June 84 $19,600.00

July 84 - June 85 $15,300.00

July 85 - June 86 $13,522.00

July 86 - June 87 $82,136.00

July 87 - June 88 $114,443.00

July 88 - June 89 $237,583.00

July 89 - June 90 $322,547.00

July 90 - June 91 $312,207.00

July 91 - June 92 $205,370.00

July 92 - June 93 $387,064.00

July 93 - June 94 $416,966.00

July 94 - June 95 $400,280.00

July 95 - June 96 $1,281,129.00

July 96 - June 97 $2,275,542.00

July 97 - June 98 $1,053,099.00

July 98 - June 99 $2,577,045.00

July 99 - June 00 $1,480,345.00

July 00 - June 01 $37,612.00

July 01 - June 02 $12,081,532.00

July 02 - June 03 $11,848,871.00

July 03 - June 04 $14,358,790.00

July 04 - June 05 $10,578,111.00

July 05 - June 06 $9,071,043.00

July 06 - June 07 $117,704,247.00

July 07 - June 08 $541,099,617.00

July 08 - June 09 $27,607,670.00

July 09 – June 10 $25,390,467.21

July 10 - June 11 $14,573,789.01

July 11 - June 12 $40,260,842.92

July 12 - June 13 $1,011,122,042.95

July 13 - June 14 $61,702,764.48

Total $1,908,637,177.57

Buddy Ludwig, Computer Programmer

Kristy Knighton, Programmer Supervisor

32

Five-year average recovered Per Position (Per year)

$2,882,624.77

the five-year (2009-2014) recovery average for the Virginia MFcu is

$230,609,981.31

annual caSe actiVity SuMMary CONTINUED

FiVe-year recoVery StatiSticS Per Filled MFcu PoSition

MFcu recovered an average of $230,609,981.31 per year over the past five

years. the MFcu has averaged 80 staff members per year over the past five

years. the recovery average per filled MFcu position for the past five years is

$2,882,624.77 per person.

REPORTING PERIODSTOTAL NUMBER OF EMPLOYEES

(EACH YEAR)July 1, 2009-June 30, 2010 52July 1, 2010-June 30, 2011 80July 1, 2011-June 30, 2012 76July 1, 2012-June 30, 2013 96July 1, 2013-June 30, 2014 97

_________________________* Since a typical health care fraud case takes two to three years to complete, a fair and accurate

performance measure of recoveries for a state MFCU would be to conduct a three-year statistical analysis of recoveries. Since a typical qui tam multi-state case takes five years to complete, a fair and accurate performance measure of those few state MFCU’s that investigate and prosecute/litigate those cases would be to conduct a five-year statistical analysis of recoveries. Since the Virginia MFCU consistently conducts those large cases, a five-year statistical analysis is provided.

FiVe-year* aVeraGe recoVered

Per nuMBer oF StaFF (Per year)

number of MFcu Staff - Five year average - 80

Patrick McDade, Assistant Attorney General/Prosecutor

Bert Mayer, Assistant Attorney General

33

2013-2014 exPenditureS

July 1, 2013 - June 30, 2014

n Non-General Fund* $ 2,455,031.72n Federal Grant $ 7,360,088.93n Indirect Costs $ 1,464,975.59TOTAL $11,280,096.24

_________________________

* Funds provided as a result of criminal convictions.

Jan Myer, Analyst

Stephanie Cothren Lloyd, Assistant Attorney General

$ 2,455,031.72

$ 7,360,088.93

$ 1,464,975.59

34

ProPoSed 2014-2015 BudGet

CATEGORY BUDGETED AMOUNT

PERSONNEL ExPENSESA. Salaries $6,544,820.00

B. Benefits $2,653,628.24

PERSONNEL ExPENSE TOTAL $9,198,448.24

NON-PERSONNEL ExPENSESA. Travel $451,292.30

B. Equipment $6,000.00

C. Special payments 0.00

D. Supplies $424,989.00

E. Contractual expenses $744,858.25

F. Other expenses $759,050.00

NON-PERSONNEL ExPENSE TOTAL $2,386,189.55

INDIRECT COSTSA. Percentage (15.54%) $1,799,320.31

GRAND TOTAL $13,383,958.10

total BudGet$13,383,958.10n Personnel Expense .................. $ 9,198,448.24

n Non-Personnel Expense .......... $ 2,386,189.55

n Indirect Cost ............................ $ 1,799,320.31

non-PerSonnel exPenSe total

$2,386,189.55n Travel .............................................. $ 451,292.30

n Equipment/Improvements ............... $ 6,000.00

n Special Payments ........................... $ 0.00

n Supplies and Materials ................... $ 424,989.00

n Contractual Expenses ..................... $ 744,858.25

n Other Expenses ................................$ 759,050.00

PerSonnel exPenSe total

$9,198,448.24n Salaries ........................................ $6,544,820.00

n Benefits ....................................... $2,653,628.24

35

the unit is committed to an aggressive training program for all staff members as a means of improving knowledge and skills in order ensure the highest quality and most efficient investigations and prosecutions.

to achieve and maintain a high level of productivity from all staff members, training and continuing education have been built into staff development. unit members have participated in programs selected to meet their individual and professional requirements, as well as to meet the needs of the unit as a whole. Following are brief descriptions of training programs attended by MFcu staff. a chart indicating dates and staff who attended is included in this report.

Many of our unit members also provided training to various groups. a description of those presentations, as well as a chart of dates and presenters, follows.

traininG

Randy Davis, Community Outreach Coordinator at a Richmond AARP event

36

traininG ProVided

triad, Seniors and law enforcement together (S.a.l.t.), and community GroupsTriad is a cooperative effort of law enforcement agencies (police/fire/sheriffs), senior citizens, and senior organizations that are focused on reducing crimes against our most vulnerable citizens. S.A.L.T. is the advisory group that carries out Triad activities. MFCU outreach workers provide training and information, upon request, at Triad, S.A.L.T., and other community group meetings.

certified Government Meeting Professionals: Put it in writingThis presentation included information on creating a request for proposal for meetings that would go out to hotels for bid. It included everything needed for a meeting to be successful and how to reach a good resolution with the hotel that submits the best bid.

Fairfax adult Protective Services: overview of the MFcu abuse & neglect SquadSpoke to a group of 18 Adult Protective Services workers about referring cases to the MFCU for follow-up and ways for investigations to become a win-win situation for both Adult Protective Services and the MFCU.

american Bar association healthcare Fraud instituteReviewed traditional abuse cases in addition to fraud associated with substandard care and fraud in billing for services provided.

Medicaid Fraud control unit Supervisor trainingThis training provided MFCU employees and Chiefs with information on documenting personnel issues, dealing with difficult people, administrative and budget overview, case management, prosecution reports, electronic case files, budgeting overview, establishing venues, and referrals.

Virginia association of chiefs of Police annual MeetingMFCU Outreach workers provided information on the work of the MFCU and the Elder Abuse and Neglect Squad and explained how to recognize and report abuse.

Jessica Smith, Assistant Attorney General

Lisa Shin, Assistant Attorney General

37

ciVil unit

StandinG, leFt to riGht: Joseph Hall, Tracey Sanders, Duncan Pence, Elizabeth Beverly, Peggy Horn, Matt Sasser, Clay Garrett, Matthew Scott, Sara Skeens, Kevin Boone, Heather Blanchard, Mathew Anderson, Michael Hnatowski, Latarsha Tyler, Jan Myer, Vince Vaccarella, Steve Irons

Seated, leFt to riGht: Lisa Shin, Jessica Smith, Caren Flick, Bert Mayer, Whitney Yarchin, Pierce Acuff, Erica Bailey, Kristie Knighton, Candice Deisher, Kristin Gray, Elizabeth Fitzgerald, Adele Neiburg, Kim Bolton, Megan Holt, Natalie Mihalek

OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA

Report Medicaid Fraud1 - 8 0 0 - 3 7 1 - 0 8 2 4

Protecting Virginians by investigating and prosecuting Medicaid providers that commit health care fraud

or patient abuse in the Commonwealth.

4495



38

dateS and PerSonnel ProVidinG traininG

Date Program Personnel7/8/13 Virginia Funeral Director’s Association Annual Conference Community Outreach Coordinator7/9/13 Abingdon Kiwanis Club Meeting Community Outreach Coordinator7/11/13 Ashland/Hanover Triad Meeting Community Outreach Coordinator7/11/13 Campbell County Triad Meeting Community Outreach Coordinator7/18/13 Chesterfield Triad Meeting Community Outreach Coordinator7/18/13 Petersburg Triad Meeting Community Outreach Coordinator7/22/13 RLSA Legal Professionals Meeting Community Outreach Coordinator7/23/13 Philip Morris Retirees Meeting Community Outreach Coordinator7/25/13 Franklin County Department of Social Services Meeting Community Outreach Coordinator7/28/13 Rustburg Department of Social Services Meeting Community Outreach Coordinator7/30/13 Rustburg Department of Social Services Meeting Community Outreach Coordinator8/1/13 Ruritan Club of Blacksburg Meeting Community Outreach Coordinator8/2/13 Lee County Triad Senior Fair Community Outreach Coordinator8/6/13 Rappahannock Hospital: Senior University Community Outreach Coordinator8/7/13 Smyth County Area Agency on Aging Meeting Community Outreach Coordinator8/8/13 Ashland/Hanover Triad Meeting Community Outreach Coordinator8/12/13 Wythe County Sheriff's Office Community Outreach Coordinator8/13/13 Chesterfield Kiwanis Meeting Community Outreach Coordinator8/15/13 Chesterfield Triad Meeting Community Outreach Coordinator8/15/13 Petersburg Triad Meeting Community Outreach Coordinator8/16/13 Prince Edward Triad Senior Event Community Outreach Coordinator8/17/13 Smyth County Area Agency on Aging Meeting Community Outreach Coordinator8/20/13 Christiansburg Triad Meeting Community Outreach Coordinator8/22/13 Chesterfield Council on Aging Meeting Community Outreach Coordinator8/22/13 Roanoke Valley Triad/SALT Council Community Outreach Coordinator8/26/13 Virginia Association of Chiefs of Police Annual Conference Community Outreach Coordinator8/26/13 Wythe County Sheriff's Office Community Outreach Coordinator8/26/13 Rural Retreat Police Department Meeting Community Outreach Coordinator9/3/13 AARP Chapter #3396 Meeting Community Outreach Coordinator9/3/13 Dinwiddie Triad Meeting Community Outreach Coordinator9/12/13 Roanoke County Department of Social Services Community Outreach Coordinator9/16/13 Virginia Sheriffs' Association Annual Conference Community Outreach Coordinator9/18/13 Gloucester County Triad Annual Safety Fair Community Outreach Coordinator9/18/13 Roanoke Local Office on Aging Meeting Community Outreach Coordinator9/19/13 Chesterfield Triad Meeting Community Outreach Coordinator9/19/13 Petersburg Triad Meeting Community Outreach Coordinator9/23/13 Prince George Triad Meeting Community Outreach Coordinator9/24/13 Franklin Co. Sheriff's Office Community Outreach Coordinator9/30/13 Senior Ambassadors Meeting Community Outreach Coordinator10/1/13 Henrico County Triad Meeting Community Outreach Coordinator10/2/13 Powhatan County Triad Meeting Community Outreach Coordinator10/4/13 Southwest Virginia Department of Social Services Supervisors’ Meeting Community Outreach Coordinator10/8/13 Mountain Empire Older Citizens Area Agency on Aging Meeting Community Outreach Coordinator10/8/13 Buchanan County Department of Social Services Community Outreach Coordinator10/9/13 Wise County Department of Social Services Community Outreach Coordinator10/10/13 Smithfield Kiwanis Club Metting Community Outreach Coordinator10/15/13 Chesterfield Parks & Recreation Department Annual Senior Fair Community Outreach Coordinator10/15/13 Certified Government Meeting Professionals: Put it in Writing Administrative Coordinator10/16/13 Westmoreland County Triad Meeting Community Outreach Coordinator10/17/13 Chesterfield Triad Meeting Community Outreach Coordinator10/23/13 Peninsula S.A.L.T. Council Senior Safety Summit Event Community Outreach Coordinator

39

Date Program Personnel10/24/13 Lyndale Baptist Church Meeting Community Outreach Coordinator10/28/13 Prince George Triad Meeting Community Outreach Coordinator10/31/13 Augusta County Department of Social Services Community Outreach Coordinator11/6/13 Powhatan County Triad Meeting Community Outreach Coordinator11/7/13 Amherst County Department of Social Services Community Outreach Coordinator11/12/13 PBL- Circle K Fraternity Meeting Community Outreach Coordinator11/12/13 Buchanan Seniors Group Community Outreach Coordinator11/13/13 Fincastle Seniors Group Community Outreach Coordinator11/14/13 Virginia S.A.L.T. Council Meeting Community Outreach Coordinator11/14/13 Ashland/Hanover Triad Meeting Community Outreach Coordinator11/25/13 Prince George Triad Meeting Community Outreach Coordinator12/4/13 Norfolk Sertoma Club Meeting Community Outreach Coordinator12/10/13 Bedford County Sheriff Community Outreach Coordinator12/11/13 Timberville Senior Center Community Outreach Coordinator12/13/13 Prince Edward Triad Senior Event Community Outreach Coordinator12/17/13 Christiansburg Triad Meeting Community Outreach Coordinator12/19/13 Chesterfield Triad Meeting Community Outreach Coordinator1/8/14 Powhatan County Triad Meeting Community Outreach Coordinator1/8/14 Lynchburg Police Department Meeting Community Outreach Coordinator1/9/14 Virginia S.A.L.T. Council Meeting Community Outreach Coordinator1/9/14 Ashland/Hanover Triad Meeting Community Outreach Coordinator1/13/14 Richmond AARP Meeting Community Outreach Coordinator1/14/14 Mechanicsville AARP Meeting Community Outreach Coordinator1/16/14 Petersburg Triad Meeting Community Outreach Coordinator1/16/14 Fairfax Adult Protective Services Meeting Criminal Investigator1/27/14 New River Criminal Justice Training Academy Meeting Community Outreach Coordinator1/30/14 Maury River Senior Center Training Event Community Outreach Coordinator2/3/14 Central Virginia Area Agency on Aging Meeting Community Outreach Coordinator2/4/14 Pittsylvania County Sheriff's Office Training Event Community Outreach Coordinator2/5/14 Powhatan County Triad Meeting Community Outreach Coordinator2/6/14 AARP Chapter #4779 Meeting Community Outreach Coordinator2/10/14 Virginia Governmental Employees Association Retirees Meeting Community Outreach Coordinator2/12/14 AARP Chapter #3049 Meeting Community Outreach Coordinator2/19/14 AARP Chapter #5425 Meeting Community Outreach Coordinator2/20/14 Chesterfield Triad Meeting Community Outreach Coordinator2/20/14 Petersburg Triad Meeting Community Outreach Coordinator2/24/14 Prince George Triad Meeting Community Outreach Coordinator2/28/14 Virginia Voice "Face to Face" Program Community Outreach Coordinator3/10/14 AARP Chapter #390 Meeting Community Outreach Coordinator3/13/14 Virginia S.A.L.T. Council Meeting Community Outreach Coordinator3/13/14 Ashland/Hanover Triad Meeting Community Outreach Coordinator3/20/14 Chesterfield Triad Meeting Community Outreach Coordinator3/20/14 Petersburg Triad Meeting Community Outreach Coordinator3/24/14 Prince George Triad Meeting Community Outreach Coordinator3/27/14 Hanover County Department of Social Services Meeting Community Outreach Coordinator3/31/14 Winchester Triad Annual Senior Festival Community Outreach Coordinator4/1/14 Henrico County Triad Meeting Community Outreach Coordinator4/2/14 Fairfax Area Agency on Aging Meeting Community Outreach Coordinator4/8/14 Chesapeake Sheriff's Office Annual Senior Seminar Community Outreach Coordinator4/10/14 Norview Seniors Group Meeting Community Outreach Coordinator4/11/14 Greenspring Center Seniors Expo Community Outreach Coordinator

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dateS and PerSonnel ProVidinG traininG (CONTINUED)

Date Program Personnel4/14/14 National Active and Retired Federal Employees’ Association Convention Community Outreach Coordinator4/17/14 Chesterfield Triad Meeting Community Outreach Coordinator4/17/14 Petersburg Triad Meeting Community Outreach Coordinator4/23/14 Virginia Sheriff's Associaiton Annual Spring Conference Community Outreach Coordinator4/28/14 Prince George Triad Meeting Community Outreach Coordinator4/29/14 Campbell County Department of Social Services Senior Citizens Event Community Outreach Coordinator4/30/14 Cascades Senior Center Meeting Community Outreach Coordinator5/7/14 Chesterfield Triad Annual Senior Day Community Outreach Coordinator5/8/14 Powhatan County Annual Senior Day Community Outreach Coordinator5/12/14 Providence United Methodist Church Retirees’ Meeting Community Outreach Coordinator5/13/14 Mathews County Triad Annual Senior Day Community Outreach Coordinator5/14/14 Chesapeake Senior Citizens Council Meeting Community Outreach Coordinator5/15/14 Petersburg Triad Meeting Community Outreach Coordinator5/16/14 American Bar Association Healthcare Fraud Institute Assistant Attorney General5/16/14 Grayson County Triad Community Outreach Coordinator5/19/14 Hanover/Ashland Triad Take-Charge Monday Event Community Outreach Coordinator5/20/14 Christiansburg Triad Community Outreach Coordinator5/22/14 Elder Justice Task Force of the New River Valley & The Landmark Group: Community Dialogue on

Financial Abuse Among Older AdultsCommunity Outreach Coordinator

5/28-5/30/14 Virginia Coalition for Prevention of Elder Abuse Conference Community Outreach Coordinator6/3-6/4/2014 Medicaid Fraud Control Unit Supervisor Training Chief of Multi-State Investigations

Administrative Manager Chief of Elder Abuse Chief Investigator for Provider Fraud Chief of Civil Investigations Deputy Director of Investigations and Audits Computer Forensic/IT Supervisor Computer Forensic Specialist Chief Section Counsel

6/4/14 Powhatan County Triad Meeting Community Outreach Coordinator6/4/14 Coordinated Community Response Team Community Outreach Coordinator6/5/14 Great Bridge United Methodist Church Seniors’ Meeting Community Outreach Coordinator6/6/14 Mount Vernon AARP Meeting Community Outreach Coordinator6/9/14 Rockingham County Triad Community Outreach Coordinator6/11/14 Martinsville Triad/SALT Senior Picnic Community Outreach Coordinator6/12/14 Elder Justice Task Force of the New River Valley Meeting Community Outreach Coordinator6/12/14 Hanover/Ashland Triad Meeting Community Outreach Coordinator6/12/14 Hampton Triad Senior Expo Community Outreach Coordinator6/16/14 Office of the Attorney General’s Interns’ Presentation Community Outreach Coordinator6/19/14 CHIMES Inc., Virginia Meeting Community Outreach Coordinator6/19/14 Petersburg Triad Meeting Community Outreach Coordinator6/23/14 Prince George Triad Meeting Community Outreach Coordinator6/24/14 Appomattox County Triad Cookout Community Outreach Coordinator6/26/14 Chesterfield Council on Aging Meeting Community Outreach Coordinator6/27/14 Warsaw-Richmond County Triad 2nd Annual Health & Safety Fair Community Outreach Coordinator

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dateS and PerSonnel ProVidinG traininG (CONTINUED)

2013 Procurement ForumProvided information on finance and purchasing, developing relationships, ethics, utilizing eVa data, suppliers and vendors, inventory management, and strategic decision making.

2014 Gatlinburg law enforcement training conferenceProvided information on entry, crime in the community, heroin and prescription drug addictions in communities, and sovereign citizens.

2014 Society of Government Meeting Professionals national education conferenceSeminar provided attendees with trainings about safeguarding your personal and business identity, how to strategically manage a government agency meeting, contract negotiations, and risk management.

23rd annual williamsburg Fraud conferenceSessions included “Hidden in Plain Sight” tips for using the Internet and social media while investigating fraud cases and an ethics course for Virginia CPAs and Non-CPAs, among many others.

a case of cancellation - Judge Judy PresidingThis program focused on an imagined scenario of the cancellation of a meeting and the cancellation policies agreed to in a contract between the meeting planner and the hotel. It reviewed what were acceptable reasons for cancellation and what, if any, damages were due to the hotel due to the cancellation of the meeting.

airline travel card Provided information on procurement of airline tickets.

airwatch connect 2013 conferenceSessions covered mobile industry trends, enterprise mobility management best practices, platform updates, and industry-specific initiatives.

american Bar association: health care Fraud conference 2013Participants heard from experts in federal litigation focusing on its unique qui tam enforcement mechanism and how it applies to all areas of the economy.

association of certified Fraud examiners dealing with dishonest employeesParticipants learned techniques to better deal with employees suspected of committing fraud.

association of certified Fraud examiners ethics for Fraud examiners & Forensic accountantsParticipants learned about ethics for Certified Fraud Examiners and Forensic Accountants.

association of certified Fraud examiners Fraud and technology SeminarParticipants learned about Medicaid fraud, computer crimes, and fraud schemes through various case studies.

traininG receiVed

Latarsha Tyler, Paralegal

David Tooker, Chief Prosecutor

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association of certified Fraud examiners: Performing as an expert witnessParticipants learned techniques to better perform as an expert witness.

association of certified Fraud examiners: the decision to ProsecuteParticipants learned factors to consider when deciding to prosecute employees suspected of committing fraud.

association of certified Fraud examiners: 25th annual conferenceThis conference offered over 70 sessions to help anyone in the anti-fraud business advance their career with professional development opportunities and discover tools and resources to help them perform at a higher level.

association of certified Fraud examiners: cyber FraudParticipants received an overview of cyber fraud.

association of certified Fraud examiners: Financial crimesParticipants received an overview of various financial crimes.

association of certified Fraud examiners: Foundations of Professional ethicsParticipants learned about the foundations of professional ethics for certified fraud examiners.

association of certified Fraud examiners: Mastering the art of the ScamParticipants received an overview of various types of fraud schemes.

association of certified Fraud examiners: two ring circus of FraudParticipants received an overview of various types of fraud schemes.

association of Government auditors: direct aid-State BudgetParticipants learned about direct aid with the state budget from the state auditor’s perspective

association of Government auditors: tax update - State auditor PerspectiveParticipants received a tax update from the state auditor’s perspective.

certified Fraud examiner’s examParticipants took an exam preparation course prior to taking, and passing, the Certified Fraud Examiners exam.

certified Government Meeting Professionals: Stump the certified Government Meeting ProfessionalThis was a game format meeting with questions from the Certified Government Meeting Professional exam to get more members interested in sitting for their exam.

combating obstructionism and attacking adverse deponent’s “i don’t Know” and “i don’t remember”This course offered a comprehensive analysis of techniques to best counter obstructionism and gamesmanship.

traininG receiVed CONTINUED

Randy Davis, Community Outreach Coordinator speaking at an event in

Campbell County

Deborah Bell, Community Outreach Coordinator at a Lynchburg event

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commonwealth’s attorneys’ Services council: annual Summer conferenceProvided information on ethics, electronic evidence, and Supreme Court updates.

computer enterprise investigations conferenceParticipants attended sessions on network forensic investigations, eDiscovery, smart phone analysis, finding malware, and basics in cyber security.

coSo internal control PracticesParticipants received training in COSO Internal Control Practices.

database administration FundamentalsThree-day course helped participants prepare for Microsoft Exam 98-364 and build an understanding of core database concepts, creating database objects, manipulating data, data storage, and administering a database.

elder abuse and domestic Violence in later life webinarThis program discussed the issues of elder abuse and domestic violence in later life. It also provided the faith-based community, service providers working with aging and violence prevention and other interested individuals with a key new resource to help them respond appropriately and assist people in abusive situations to get the help they need.

Fraud Prevention controls & coSo 2014Participants received training in fraud prevention controls and COSO.

Georgetown university law School: advanced ediscovery instituteProgram provided attendees with an opportunity to learn from the leading eDiscovery practitioners and academics from across the country. A combination of plenary sessions and targeted break-out sessions allowed them to be exposed to the latest case law, trends in all aspects of eDiscovery, and judicial and practitioner perspectives.

health care industryParticipants received an overview of the health care industry.

health Plan engagementParticipants learned updates to technology advancements in health plans.

individual travel cardThe Commonwealth of Virginia regulations require that travel cardholders complete an annual training webinar and quiz to review the existing rules and any new regulations in order to be able to maintain an office travel card.

Kickstart internal audit 2014Participants learned about internal audit updates for 2014.

Kimberly Wilborn, Paralegal

Pierce Acuff and Vince Vaccarella, Assistant Attorneys General

44


Mapping controls to PrinciplesParticipants learned about mapping internal controls to management’s principles.

Mistake Free Grammar and ProofreadingTraining was provided to staff to focus on contemporary grammar skills and the newest standards in business usage and improving communicating in writing.

national association of Medicaid Fraud control units: 101 trainingProvided information on global process overview, federal and state False Claims Act practice, fraud schemes, data analysis, damage models, and negotiations.

national association of Medicaid Fraud control units: 102 trainingProvided workshops related to mental health, durable medical equipment, cost report fraud and resident neglect and other topics related to Medicaid fraud and related investigation.

national association of Medicaid Fraud control units: annual training ProgramParticipants attended various sessions covering multiple topics including streamlined interstate civil discovery, intervention and litigation in multi-state false claims cases, and using prescription monitoring program databases to make medicaid fraud cases.

national association of Medicaid Fraud control units: directors’ SymposiumThis is annual meeting brings together directors of all of the states’ MFCU units to discuss successes and trends.

national association of Medicaid Fraud control units: eastern regional MeetingRepresentatives from the Eastern Region (Virginia, Maryland, Delaware, New Jersey, New York, Washington D.C., Pennsylvania, and West Virginia) met to discuss issues and best practices involving various topics including obtaining substance abuse records, unit policies and procedure manuals, and requirements for physicians under ACAF.

national association of Medicaid Fraud control units: Global intake trainingAttorneys from all of the states’ MFCU units work together to discuss various global settlement cases of Medicaid provider fraud.

national association of Medicaid Fraud control units: team lead trainingThis training was designed to provide legal updates to attorneys and analysts participating on the global settlement process. Covered topics include damages models, global settlement language, and working with counsel from the Department of Justice, relators and defense counsel.

national district attorneys’ association’s Successful trial Strategies courseParticipants were provided with up-to-the-minute instruction on trial advocacy skills, trial preparation, and other methodologies that assist prosecutors in improving their skills inside the courtroom.

national health care anti-Fraud association analyzing the data ProgramProvided a forum for private and public sector members to come together to share information and discuss active health care fraud investigations as well as schemes, trends, and fraud patterns.

national health care anti-Fraud association annual conferenceProvided information for fighting fraud and information on emerging trends for successful fraud prevention.

45

national health care anti-Fraud association health care Fraud investigator’s Boot campTraining included understanding the basics of the American health care system, both private and public, key policies and laws that frequently impact negotiations, learning the basics of health care fraud schemes, investigatory process, health care fraud regulations, detecting fraud, waste and abuse, Internet strategies, and interview skills including an interactive group practice with faculty.

national health care anti-Fraud association: excel techniques to effectively Mine dataThis course covered how to use Excel to mine data and visualize results including database structure, pivot tables, and graphing.

national health care anti-Fraud association: Skills and Schemes for the health care Fraud investigatorParticipants explored current trends, red flags, case examples, and fraud schemes in a variety of specialty areas, while considering the investigative skills necessary to conduct successful health are fraud investigations.

national institute for trial advocacy: deposition trainingParticipants explored the “tried and true” practices in both taking and defending depositions using cutting edge techniques developed by NITA.

national insurance crime Bureau Major Medical Fraud task ForceMulti-jurisdictional task force training to present and discuss different cases involving healthcare fraud.

national white collar crime center: Financial investigation Practical SkillsProvided hands-on training designed specifically to address the particular interests and needs of white collar crime investigators.

national white collar crime center: intellectual Property theft SeminarAttendees learned about the sale of counterfeit products that involve serious health and safety issues in addition to impacting the economy.

national white collar crime center: Metadata and exiF tags - what criminal investigators and analysts need to KnowProvided attendees with an understanding of metadata, how it is created, how it is transmitted, how to recover it, and how to use it in investigations.

national white collar crime center: Perphound webinarPresentation demonstrated the features and capabilities of PerpHound, which is free to law enforcement and simplifies the analysis of location information found in call detail records by merging cell tower records with call detail records when creating a file which can be opened in most available mapping utilities.

Community Outreach Coordinator Randy Davis(left) shared a moment with member Bill Areybefore addressing the Philip Morris USA and Altria Retirees’ Association on the growing problems of Medicaid Fraud and Elder Abuse.

The annual Senior Appreciation Day Picnic of the Martinsville/Henry County Triad/S.A.L.T. Council was held at Jack Dalton Park. Among those in attendance were (l-r) Martinsville Police Chief Sean Dunn, MFCU Western Virginia Community Outreach Coordinator Debbie Bell, Martinsville Sheriff Steve Draper, Martinsville/Henry County Victim/Witness Program Coordinator Vicky Belcher, Martinsville/Henry County Triad/S.A.L.T. Council President Stephanie LaPrade, Attorney General Mark Herring, and Henry County Sheriff Lane Perry.

46


national white collar crime center: what investigators and analysts need to Know about hiding on the internetParticipants learned about the ability to hide one’s identity and location on the Internet and how to use new technologies, such as digital device fingerprinting, to better investigate.

new horizons Programming with VBa in excel Introductory class to Visual Basic programming.

office of the inspector General: interviewing techniques for auditorsThis two-day course focused on the Wicklander-Zulawski’s method of non-confrontational interview and interrogation. The goal of the non-confrontational interrogation is to avoid any denial on the part of the suspect but rather transition directly into an admission of guilt. Much of the training pertained to observation and interpretation of physical and verbal behavior, signs of deception, stress, recall, and truthfulness. The course also dealt with the “behavior analysis interview,” during which an interviewer may develop a suspect in spite of very little factual information concerning the specific details of the crime.

Quarterly accounting updateParticipants trained on RAT-STATS, a statistical software package that providers can download to assist in a claims review.

reid School of interview and interrogationAttendees met to further develop their investigative skills by attending quality training programs from a variety of fields related to investigations.

relativity administrative trainingProvided information on administration of Relativity cases for litigation support professionals and case managers.

relativity FestThis event covered a variety of topics regarding Relativity including sales training, workflows for large workspaces, using Relativity applications to solve everyday problems, and a workshop on custom pages, agents, and ADS.

Safety in the Golden yearsParticipants attended sessions regarding financial crimes, creating elder abuse and fraud awareness in your community, and how to prevent and respond to crimes against seniors.

Small Purchase credit card trainingProvided information and regulations for use of small purchase credit card.

tax controversies developmentsParticipants received tax updates and developments.

1st Vice President Vernon L. Wildy (left) welcomed MFCU Community Outreach Coordinator Randy Davis, before Davis addressed the Chamberlayne AARP Chapter meeting at Ebenezer Baptist Church in Richmond.

MFCU Community Outreach Coordinator Randy Davis (left) appeared on WCTV-TV’s news and talk program, “Thinking Out Loud”, hosted by Mark Cox (right). Davis provided information about the growing problems of Medicaid fraud and elder abuse on the program, seen by an estimated 1,000 viewers in the Chesapeake region.

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techead adobe indesign c6 introduction trainingParticipants were introduced to Adobe InDesign and were oriented with the program, functions, and most popular tools.

the Growing challenge of Medical identity theftTraining included examples of medical identity theft (MIT), descriptions of who perpetrates MIT, initiatives to limit MIT, what happens when an individual’s medical identity is stolen, and detection techniques.

the institute of internal auditors’ audit SeminarParticipants attended “Increasing Auditor Effectiveness in Recognizing and Detecting Fraud” that presented suggestions for detection and for creating an environment, which promotes discovery of fraud. During “Behavior & Communication Skills for Auditors,” they learned how to better understand themselves and others as well as specific suggestions so auditors can be more effective in achieving desired results.

the new normal Government Meetings and you in 2014Provided participants with information on how to be more effective in government meetings and what current actions that may actually hurt you in the “new normal.”

traditional investigative techniquesParticipants learned traditional investigative techniques in an audit.

Virginia coalition for the Prevention of elder abuse annual conferenceProvided an introduction to the basics of adult prosecution in cases of elder abuse, neglect, and exploitations for those new to the fields of adult protection or abuse prosecution.

Virginia information technologies agency: introduction to electronic discoveryParticipants received training in electronic discovery.

Virginia local Government auditors’ association’s Fall conferenceParticipants learned audit techniques through various case studies.

Virginia local Government auditors’ association’s Spring conferenceParticipants received training in using data analytics to detect fraud and errors.

Virginia Society of certified Public accountants’ Government accounting Standards Board updateParticipants received a training update on Governmental Accounting Standards.

Virginia State Bar Professionalism courseThis course covered Professionalism and the Virginia Rules of Professional Conduct. Attendees received instruction on lawyers’ ethical obligations to their clients, the judicial system and to society.

Virginia tech income tax SchoolParticipants learned how to identify the effect and sunset dates established by new tax legislation, how to apply rules to assist the individual taxpayer, verify selected new rulings and cases, and many other tax topics.

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dateS and PerSonnel receiVinG traininG

Date Program Personnel7/9/13 National White Collar Crime Center: Metadata and ExIF Tags - What Criminal Investigators and

Analysts Need to KnowTwo Investigators

7/22/13-7/23/13 National Health Care Anti-Fraud Association: Analyzing the Data Program Assistant Attorney General

7/22/13-7/28/13 National Association of Medicaid Fraud Control Units: 101 Training Assistant Attorney General Investigator

7/31/13 National White Collar Crime Center: PerpHound Webinar Investigator

8/1/13 Certified Fraud Examiner's Exam Investigative Supervisor Financial Investigator Senior Financial Investigator

8/1/13-8/4/13 Commonwealth’s Attorneys’ Services Council: Annual Summer Conference Chief Section Counsel Two Assistant Attorneys General

8/6/13 National White Collar Crime Center: What Investigators and Analysts Need to Know about Hiding on the Internet

Senior Investigator Financial Investigator Two Investigators

8/8/13 Association of Certified Fraud Examiners: Performing as an Expert Witness Investigator

8/14/13 National White Collar Crime Center: Intellectual Property Theft Seminar Investigative Supervisor Two Investigators

8/27/13 Elder Abuse and Domestic Violence in Later Life Webinar Analyst/Community Outreach Coordinator

9/3/13 Association of Certified Fraud Examiners: The Decision to Prosecute Investigator

9/4/13-9/5/13 TecHead Adobe InDesign C6 Introduction Training Administrative Manager Community Outreach Coordinator

9/8/13-9/13/13 AirWatch Connect 2013 Conference Computer Forensic - IT Supervisor

9/9/13-9/13/13 National Association of Medicaid Fraud Control Units: 102 Training Five Investigators

9/10/13-9/13/13 National Association of Medicaid Fraud Control Units: Global Intake Training Computer Programmer Assistant Attorney General

9/12/13 Virginia State Bar Professionalism Course Two Assistant Attorneys General

9/13/13 Association of Certified Fraud Examiners: Dealing with Dishonest Employees Investigator

9/13/13-9/20/13 National Health Care Anti-Fraud Association: Skills and Schemes for the Health Care Fraud Investigator

Senior Criminal Investigator Financial InvestigatorInvestigative Supervisor

9/15/13-9/20/13 National White Collar Crime Center: Financial Investigation Practical Skills Senior Investigator

9/17/13 Combating Obstructionistm and Attacking Adverse Deponent's "I Don't Know" and "I Don't Remember"

Assistant Attorney General

9/18/13 Committee of Sponsoring Organizations of the Treadway Commission Update Investigator

9/18/13-9/19/13 Office of the Inspector General: Interviewing Techniques for Auditors Senior Financial Investigator Financial Investigator Six Investigators

9/27/13 Virginia Local Government Auditors Association: Fall Conference Two Investigators

10/1/13 Health Plan Engagement Investigator

10/6/13-10/8/13 Relativity Fest Two eDiscovery Analysts eDiscovery Supervisor

10/6/13-10/11/13 National Association of Medicaid Fraud Control Unit’s Annual Training Program Director Chief Section Counsel Chief Investigator Investigative Supervisor Deputy Director of Investigations and Audit Assistant Attorney General

10/11/13 Association of Certified Fraud Examiners: Foundations of Professional Ethics Investigator

10/16/13 Association of Certified Fraud Examiners: Fraud and Technology Seminar Investigator

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Date Program Personnel10/17/13-10/20/13 2013 Procurement Forum Administrative Coordinator

10/28/13-10/30/13 Database Administration Fundamentals Computer Programmer

11/4/13-11/5/13 Virginia Tech Income Tax School Financial Investigator

11/6/13 Association of Certified Fraud Examiners: Ethics for Fraud Examiners & Forensic Accountants Investigator

11/6/13 Mistake Free Grammar and Proofreading Program Unit Coordinator

11/6/13 RAT-STATS Training Investigator

11/12/13-11/13/13 The Institute of Internal Auditors: Audit Seminar Investigative Supervisor Senior Financial Investigator Financial InvestigatorThree Investigators

11/17/13-11/22/13 National Health Care Anti-Fraud Association: Annual Conference Administrative Manager Two Community Outreach Coordinators Two InvestigatorsThree Nurse Investigators

11/21/13-11/22/13 Georgetown University Law Center's Advanced eDiscovery Institute Chief of Civil Investigations Unit/AAG Five Assistant Attorneys General

12/17/13 Traditional Investigative Techniques Investigator

12/20/13 Virginia Society of Certified Public Accountants: Government Accounting Standards Board Update Investigator

1/8/14 Virginia Information Technologies Agency: Introduction to Electronic Discovery Investigator

1/9/14 Kickstart Internal Audit in 2014 Investigator

1/15/14 Association of Government Auditors: Tax Update - State Auditor Perspective Investigator

1/16/14 Quarterly Accounting Update Investigator

1/22/14 Association of Certified Fraud Examiners: Mastering the Art of the Scam Investigator

1/27/14-1/31/14 National District Attorneys Association: Successful Trial Strategies Course Assistant Attorney General

2/5/14 A Case of Cancellation - Judge Judy Presiding Administrative Coordinator

2/10/14-2/14/14 National Association of Medicaid Fraud Control Units: 102 Training Nurse InvestigatorInvestigator

2/19/14 Tax Controversies Developments Investigator

2/20/14 The New Normal: Government Meetings and You in 2014 Administrative Coordinator

2/24/14-2/26/14 Relativity Administrative Training Two eDiscovery Analysts

2/28/14 Association of Certified Fraud Examiners: Financial Crimes Investigator

3/3/14-3/6/14 National Association of Medicaid Fraud Control Units: 101 Training Investigator

3/6/14 Association of Certified Fraud Examiners: Two Ring Circus of Fraud Investigator

3/10/14-3/14/14 National Health Care Anti-Fraud Association: Health Care Fraud Investigator's Boot Camp Financial InvestigatorInvestigator

3/19/14 Association of Government Auditors: Direct Aid-State Budget Investigator

3/19/14 Individual Travel Card Grants Manager Administrative Coordinator

3/20/14 Health Care Industry Investigator

3/21/14 Association of Certified Fraud Examiners: Cyber Fraud Investigator

3/24/14 Airline Travel Card Administrative Coordinator

3/24/14 Small Purchase Credit Card Training Administrative Coordinator

3/26/14-3/27/14 National Association of Medicaid Fraud Control Units: Directors Symposium Director

4/7/14-4/9/14 National Association of Medicaid Fraud Control Units: Eastern Regional Meeting DirectorInvestigative Supervisor Deputy Director of Investigations and Audit

50

dateS and PerSonnel receiVinG traininG CONTINUED

Date Program Personnel4/8/14 National Insurance Crime Bureau: D.C. Major Medical Fraud Task Force Investigative Supervisor

Senior Finanacial Investigator Financial InvestigatorNurse Investigator Four Investigators

4/9/14-4/10/14 National Institute for Trial Advocacy: Deposition Training Chief of Civil Investigations Unit Lead Attorney Nine Assistant Attorneys General Two Investigator Supervisors Two Investigators

4/10/14 Safety in the Golden Years Legal Secretary

4/23/14 Mapping Controls to Principles Investigator

4/24/14-4/25/14 23rd Annual Williamsburg Fraud Conference Two Financial Investigators

5/2/14 Fraud Prevention Controls & COSO 2014 Investigator

5/5/14-5/9/14 2014 Gatlinburg Law Enforcement Training Conference Senior Investigator

5/5/14-5/9/14 2014 Society of Government Meeting Professionals: National Education Conference Administrative Coordinator

5/12/14-5/15/14 Reid School of Interview and Interrogation Three Investigators

5/13/14 COSO Internal Control Practices Investigator

5/13/14-5/17/14 American Bar Association: Health Care Fraud Conference 2013 Four Assistant Attorneys General (Civil)

5/14/14 Certified Government Meeting Professionals: Stump the CGMP Administrative Coordinator

5/18/14-5/23/14 Computer Enterprise Investigations Conference Computer Forensic - IT SupervisorComputer Forensic Analyst

5/19/14 Virginia Local Government Auditors Association: Spring Conference Investigator

5/22/14 Health Care Industry Investigator

5/28/14-5/30/14 New Horizons: Programming with Excel Programmer Supervisor

5/28/14-5/30/14 Virginia Coalition for the Prevention of Elder Abuse: Annual Conference Two Investigators Community Outreach Coordinator Administrative Coordinator Legal Secretary Grants Manager

6/1/14-6/6/14 Georgetown University Law School's Advanced eDiscovery Institute Three Assistant Attorneys General

6/3/14-6/7/14 American Bar Association: 10th National Institute on the False Claim Act Conference Two Assistant Attorneys General

6/5/14 The Growing Challenge of Medical Identity Theft Senior InvestigatorLegal Secretary

6/9/14-6/12/14 National Association of Medicaid Fraud Control Units: Team Lead Training Chief of Civil Investigations UnitChief of eDiscovery and Litigation Support

6/15/14-6/19/14 Association of Certified Fraud Examiners: 25th Annual Conference Investigative Supervisor Senior Financial Investigator Financial Investigator Three Investigators

6/24/14 National Health Care Anti-Fraud Association: Excel Techniques to Effectively Mine Data Senior Investigator

Agency Street Address:

Office of the Attorney General of Virginia900 East Main StreetRichmond, Virginia 23219Phone (804) 786-2071 (804) 786-2072 (main numbers) 1-800-371-0824Fax (804) 786-3509

Regional Offices:

Northern Virginia Regional Office 10555 Main Street, Suite 350 Fairfax, Virginia 22030 Phone (703) 277-3540Fax (703) 277-3547

Southwest Regional Office 204 Abingdon Place Abingdon, Virginia 24211Phone (276) 628-2759Fax (276) 628-4375

Western Regional Office3033 Peters Creek RoadRoanoke, Virginia 24019Phone (540) 562-3570Fax (540) 562-3576

To Report Medicaid fraud:

If you would like to report a suspected case of Medicaid fraud or have questions, please contact us at Phone 1-800-371-0824 or (804) 786-2071 or (804) 786-2072

The Unit can be contacted by mail at:900 East Main StreetRichmond, Virginia 23219or by email: [email protected]

OAG Web Sites:www.ag.virginia.govwww.facebook.com/VAMFCUhttp://tinyurl.com/VAMFCUwww.pinterest.com/VAMFCUwww.twitter.com/VaMFCU

You may report recipient fraud to the Department of Medical Assistance Services at: [email protected]

Additional Information

Copies of the Office of the Attorney General of Virginia’s Medicaid Fraud Unit’s Annual Report are available without charge. This report may be viewed, downloaded or printed by visiting http://tinyurl.com/VAMFCU and clicking on “Publications”, or requests for this item can be made by contacting:

Esther Welch Anderson, ManagerAdministrative, Training and OutreachMedicaid Fraud Control UnitVirginia Attorney General’s Office900 East Main StreetRichmond, VA 23219

[email protected] (804) 692-0519 1-800-371-0824 toll free (804) 371-0779 local

Credits

Design:Virginia Office of Graphic Communications Department of General Services 1100 Bank Street, Suite 420Richmond, VA 23219

Report compiled by:

Esther Welch AndersonMFCU Administrative, Training and Outreach ManagerMedicaid Fraud Control UnitOffice of the Attorney GeneralRichmond, Virginia 23219

The Virginia Attorney General’s Office’s Medicaid Fraud Control Unit is located in the Pocahontas Building in Richmond, Virginia.

Medicaid Fraud Control Unit

Office of the Attorney General 900 East Main Street, Richmond, VA 23219

Toll-Free 1-800-371-0824 Richmond area (804) 786-2071 or (804) 786-2072

(804) 786-3509 (fax)

[email protected]



2013 rePort - MultiBriefs · Between 1998 and 2008, Abbott promoted Depakote for the unapproved FDA...

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