2008-2009 ANNUAL REPORT - Virginia Attorney General

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STATUTORY AUTHORITY 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 Virginia Attorney General’s Office’s Medicaid Fraud Control Unit successfully proposed legislation to eliminate the penalty for abuse or neglect of an incapacitated adult that resulted in death to a Class 3 felony, which is a term of imprisonment of not less than five years nor more than 20 years and a fine of not more than $100,000. 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 also enacted a number of changes to health care fraud statutes in Virginia to ensure Virginia would be deemed compliant with the federal Deficit Reduction Act of 2005. If deemed compliant, Virginia would be allowed to keep an additional 10% of the recoveries. • 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 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, and 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 pursuant to a provider agreement. 2007 Va. Acts, c. 569. 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 scheme was in compliance. 4
UNIT MISSION 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, when appropriate, to reinforce and instill in the provider community a desire to comply with all regulations promulgated by the Virginia Department of Medical Assistance Services (DMAS); 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. Virginia’s Capitol which was designed by Thomas Jefferson and is the centerpiece of Capitol Square 5
Page 1: OFFICE OF THE ATTORNEY GENERAL OF T
Page 5 and 6: TABLE OF CONTENTS LETTER FROM THE M
Page 7: PREFACE The Virginia Medicaid Fraud
Page 11 and 12: ORGANIZATIONAL CHART Office of the
Page 13 and 14: United States v. Mohamed A. Abdelsh
Page 15 and 16: DETAILED CASE SUMMARY Criminal July
Page 17 and 18: DETAILED CASE SUMMARY Civil July 1,
Page 19 and 20: ELDER ABUSE AND NEGLECT SQUAD The E
Page 21 and 22: PROJECTIONS FOR 2009-2010 FISCAL YE
Page 23 and 24: UNIT ACTIVITIES/EXPANSION Social Se
Page 25 and 26: TRAINING RECEIVED 18th Annual Ethic
Page 27 and 28: TRAINING RECEIVED National Adult Pr
Page 29 and 30: Dates and Personnel attending Train
Page 31 and 32: Dates and Personnel attending Train
Page 33 and 34: TRAINING PROVIDED National Associat
Page 35 and 36: ANNUAL CASE ACTIVITY SUMMARY Fiscal
Page 37 and 38: PROPOSED 2009-2010 BUDGET Personnel
Page 39 and 40: Agency Street Address: Virginia Att

2008-2009 ANNUAL REPORT - Virginia Attorney General

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