MEDICAID FRAUD CONTROL UNIT - Office of the Attorney General

Attorney General Kenneth T. Cuccinelli, IIThe men and women working in the MedicaidFraud Unit continue to surpass milestones in theirfight to protect the health and welfare of theresidents of the Commonwealth.We are pleased to offer the Medicaid FraudControl Unit’s 2010 Annual Report.Medicaid Fraud Control UnitOffice of the Attorney General900 East Main Street, Richmond, VA 23219(804) 786-2071iii

TABLE OF CONTENTSLETTER FROM DIRECTOR AND CHIEF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3PREFACE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4STATUTORY AUTHORITY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5UNIT MISSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6OFFICE OF THE ATTORNEY GENERAL PERSONNEL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7ORGANIZATIONAL CHART . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8SIGNIFICANT CASES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Criminal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Commonwealth v. Barbara Ann Napier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Commonwealth v. Coleman Floyd . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Commonwealth v. James William Wright . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Commonwealth v. JoAnn Williams. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Commonwealth v. Kadiatu Diallo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Commonwealth v. Linda Sluss Bishop, LPN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Appeals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14United States v. Mohamed A. Abdelshafi. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Detailed Case Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15CIVIL INVESTIGATIONS SQUAD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Civil. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Best Price Fraud: Aventis Settlement.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Medicaid Rebate Program Fraud: Innovator v. Non-innovator Classification. . . . . . 17Off-label Marketing and Kickbacks: Pfizer Settlement . . . . . . . . . . . . . . . . . . . . . . . . . . 17Detailed Case Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19CASE ACTIVITY SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20ELDER ABUSE AND NEGLECT SQUAD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21UNIT PROJECTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22PROJECTIONS FOR 2010-2011 FISCAL YEAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23UNIT PERFORMANCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Three Year Recovery Statistics Per Filled MFCU Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24UNIT ACTIVITIES/EXPANSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25ANNUAL CASE ACTIVITY SUMMARY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Fiscal Years 1982 through 2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Three-Year Recovery Average (per year) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Number of MFCU Staff - Three Year Average. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Three-Year Average Recovered Per Number of Staff (per year). . . . . . . . . . . . . . . . . . . . . . 27PROPOSED 2010-2011 BUDGET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282009-2010 EXPENDITURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29TRAINING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Training Provided. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31Dates and Personnel Providing Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Training Received. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Dates and Personnel Attending Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391

Kenneth T. Cuccinelli, IIAttorney GeneralThe Honorable Kenneth T. Cuccinelli, IIAttorney General of Virginia900 East Main StreetRichmond, VA 23219COMMONWEALTH of VIRGINIAOffice of the Attorney GeneralJune 30, 2010900 East Main StreetRichmond, Virginia 23219804-786-2071FAX 804-786-1991Virginia Relay Services800-828-11207-1-1Dear General Cuccinelli:On October 1, 1982, the United States Department of Health and Human Services formally designated and certifiedthe Virginia Medicaid Fraud Control Unit (MFCU or the Unit) as an integral part of the nationwide effort to deter fraudand the misapplication of funds by health care providers enrolled in the Commonwealth’s Medical Assistance Program,which is administered by the Virginia Department of Medical Assistance Services (DMAS). This year, as a result of ourcriminal and civil investigations, the MFCU has successfully recovered significant amounts of money wrongfully paid toproviders by Virginia’s Medicaid program. The MFCU achieved its fourth most successful year since its inception andobtained convictions of 13 healthcare providers in state and federal courts, with $25,390,467.21 of restitution orderedto be paid to Medicaid. In addition to maintaining its normal significant caseload, the members of MFCU also trainedeight new employees.The outstanding performance of the MFCU is attributable to a team effort, the Unit’s exceptional relationship withother state and federal agencies, and the continued support from you and your senior staff. The tremendous successof the Unit this year could not have been achieved without the persistent work performed by the men and women ofthe MFCU, who spend many days away from families and friends while conducting surveillances, executing searchwarrants, analyzing records, conducting interviews, and prosecuting cases. The Unit’s commitment to the Office of theAttorney General and its mission is why, in 2008, we were named the number one MFCU in the country by the UnitedStates Department of Health and Human Services, Office of Inspector General (HHS-OIG). The MFCU is proud to serveamong the nation’s leaders in combating fraud in the Medicaid program. We thank you for your continued support andencouragement.The report that follows reviews the first half of the 2009-2011 biennium, from July 1, 2009 to June 30, 2010, and setsforth the organization, operations, and accomplishments of the Unit.With kindest regards, I remainVery truly yours,Randall L. ClouseDirectorMedicaid Fraud Control UnitHealth Care Fraud and Elder Abuse Section3

PREFACEThe Virginia Medicaid Fraud Control Unit (MFCU or the Unit) of the Office of theAttorney General was certified October 1, 1982, by the United States Department ofHealth and Human Services. The Unit is one of fifty similarly structured units throughoutthe 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 interestand for the protection of the health and welfare of the residents of theCommonwealth that a proper regulatory and inspection program beinstituted in connection with the providing of medical, dental and otherhealth services to recipients of medical assistance. In order to effectivelyaccomplish such purpose and to assure that the recipient receivessuch services as are paid for by the Commonwealth, the acceptance bythe recipient of such services and the acceptance by practitioners ofreimbursement for performing such services shall authorize the AttorneyGeneral or his authorized representative to inspect and audit all records inconnection with the providing of such services. Section 32.1-310, Code ofVirginia, 1950, as amended.4 4

STATUTORY AUTHORITYIn 1981, the Virginia General Assembly enactedChapter 9, §§ 32.1-310 through 32.1-321 of the Codeof Virginia to regulate medical assistance in theCommonwealth. This Chapter authorizes criminalsanctions 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 Officeof the Attorney General in accordance with federalrequirements. This Unit is separate and distinct fromthe Department of Medical Assistance Services (DMAS),which is the single state agency in the executive branchresponsible for the administration of the Medicaidprogram.In 1995, the General Assembly significantly amendedthe Medicaid fraud statutes by converting Virginia Code§ 32.1-314, the most frequently charged crime under theMedicaid fraud statutes, from alarceny-type offense to afalse-claims offense. The change eliminated the requirementthat the Commonwealth prove $200 or more waswrongfully taken from the program in order to securea felony conviction. Under the amended statute, theCommonwealth need only prove that a materially falsestatement was made in an application for reimbursementunder the program.In 2007, the Unit successfully proposed legislationto elevate the penalty for abuse or neglect of an incapacitatedadult that resulted in death to a Class 3 felony,which is a term of imprisonment of not less than fiveyears nor more than 20 years and a fine of not more than$100,000 (2007 Va. Acts cc. 562, 653). Before the 2007amendment, abuse of an incapacitated adult resulting inserious bodily injury or disease was a Class 4 felony punishableby a term of imprisonment of not less than twoyears nor more than 10 years and a fine of not more than$100,000. In 2007, the General Assembly also enacteda number of changes to health care fraud statutes inVirginia to ensure Virginia would be deemed compliantwith the federal Deficit Reduction Act of 2005. If deemedcompliant, Virginia would be allowed to keep an additional10% of the recoveries.• Amended Virginia Code § 8.01-216.3 to increasethe minimum penalty from $5,000 to $5,500 andincrease the maximum penalty from $10,000 to$11,000;• Amended Virginia Code § 8.01-216.3 to allowthe Virginia Attorney General’s Office to recoverattorney fees and costs incurred in its investigationand prosecution of qui tam actions;• Amended Virginia Code §§ 8.01-216.5 and8.01-216.6 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) extendthe statute of limitations period; (2) extend theburden of proof requirement; and (3) preventdefendants from denying civil liability if they areconvicted in a criminal proceeding based on thesame transaction or occurrence; and• Amended Virginia Code §§ 32.1-312 and32.1-313 to extend the statute of limitations andallow Virginia to bring a civil action for fraudagainst health care subcontractors that provide services or goods to Medicaid recipients, butdo not contract directly with Virginia’s stateprovider pursuant to a provider agreement.2007 Va. Acts, c. 569. The United States Departmentof Health and Human Services, Office of the InspectorGeneral issued a ruling on March 13, 2007 that foundVirginia’s statutory scheme was in compliance.5

UNIT MISSIONThe Unit is charged with the investigation and prosecution of Medicaid providerswho conduct their businesses in a fraudulent or highly abusive manner. The intendedresult of this effort is to deter all providers of medical services from engaging in thesetypes of behaviors.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 againsthealthcare fraud and patient abuse and neglect throughout the Commonwealth. In fact, the MFCU is uniquely positioned to take the lead in investigating and prosecutinghealthcare fraud and patient abuse and neglect in the Commonwealth;Seek alternatives to criminal prosecution, when appropriate, to reinforce and instill inthe provider community a desire to comply with all regulations promulgated by theVirginia Department of Medical Assistance Services (DMAS);Provide educational resources to the community, law enforcement, and other agenciesthrough presentations on the work of the MFCU, and the publishing of a quarterlynewsletter and brochures which provide information on Medicaid fraud as well as elderand patient abuse and neglect;Refine internal operating procedures designed to produce timely investigative resultsand maximize Unit resources in order to promote efficient and thorough strategies foreach case;Promote effective communication between the Unit and DMAS, thereby increasing thenumber and quality of referrals;Maintain the highest standards of excellence through aggressive training on currentfraud trends and law enforcement tools in an attempt to better combat fraud in theMedicaid program; andProvide assistance related to nationwide civil and criminal healthcare fraud matters.America’s oldest English-speaking representative assemblyhas been meeting in the Virginia State Capitol since 1788.6

ORGANIZATIONAL CHARTOffice of the Attorney GeneralPublic Safety and Enforcement DivisionHealth Care Fraud and Elder Abuse SectionMedicaid Fraud Control UnitJune 30, 2010AdministrativeManagerUnit ProgramCoordinatorAdministrativeCoordinatorDeputy Directorof InvestigationsChief ofElder AbuseChief InvestigatorProvider FraudUnitSr. CriminalInvestigatorCriminalInvestigatorInvestigativeSupervisorInvestigativeSupervisorInvestigativSupervisorCriminalInvestigatorSr. CriminalInvestigatorSr. CriminalInvestigatorAbingdonInvestigatoNurseInvestigatorCriminalInvestigatorInvestigativeAnalystAbingdonInvestigatoNurseInvestigatorNurseInvestigatorSr. CriminalInvestigatorAbingdonInvestigatoNurseInvestigatorCriminalInvestigatorSr. CriminalInvestigatorAbingdonInvestigatoNurseInvestigatorNOVASr. CriminalInvestigatorNOVACriminalInvestigatorAbingdonEvidenceManager/AnaNurseInvestigatorRichmondSr. CriminalInvestigatorNOVASr. CriminalInvestigatorRoanokeAnalystInvestigatorSr. CriminalInvestigatorSr. CriminalInvestigatorRoanoke8InvestigatorSr. CriminalInvestigatorRoanoke

Attorney GeneralChief DeputyAttorney GeneralDeputyAttorney GeneralChiefHealth Care Fraud and Elder AbuseMEDICAID FRAUD CONTROL UNITVIRGINIA OFFICE OF THE ATTORNEY GENERALDirectorMedicaid Fraud UnitDeputy DirectorProsecution &LitigationMFCU ComputerForensic-ITSupervisorChief AuditorAudit UnitChief ProsecutorCriminalProsecutions UnitChief of CivilInvestigationUnitForensic & ITSpecialistAuditorAbingdonLead AAGLead AAGLead AAGeInvestigatorForensicAccountantNOVAAAGProsecutorAAGAAGrInvestigatorAuditorAAGProsecutorNorfolkCivilInvestigatorAAGrInvestigatorSenior AuditorAAGProsecutorRoanokeParalegalAAGrInvestigatorAuditorAAGProsecutorNOVALegalSecretaryComputerProgrammerrCriminalInvestigatorSSA AshlandAuditorParalegalComputerProgrammerSecretarylystCriminalInvestigatorSSA AshlandAAGAAGParalegalAAG9

SIGNIFICANT CASESThe following are brief summaries of significantcases that resulted in the successful convictionsof numerous fraudulent healthcare providers inthe Commonwealth during fiscal year 2009-2010.10

CRIMINAL CASESCOMMONWEALTH V. BARBARA ANN NAPIERCHECKER CAB A/K/A CHECKER EZ CABOn December 3, 2009, Barbara Ann Napier (Napier)pled guilty to three counts of Medicaid Fraud (Va. Code §32.1-314) and three counts of Obtaining Money by FalsePretenses (Va. Code § 18.2-178) in Albemarle CountyCircuit Court. On March 23, 2010, Napier appeared inAlbemarle County Circuit Court for sentencing. Napierwas sentenced to 42 years’ incarceration with 40 yearssuspended, leaving her an active term of 2 years’imprisonment. Additionally, Napier was ordered to pay$420,000.00 in restitution. The Commonwealth’s evidenceshowed that from 2006 through 2008, Napiercontrolled the billing and management of Checker Cab.Checker Cab is a transportation company under contractwith Medicaid HMO Virginia Premier to provide transportationservices to Medicaid recipients. Napier overbilledVirginia Premier approximately $420,000 by submittingfalse claims for reimbursement that reflected more milesthan actually traveled. Further, Napier fraudulently representedthat “after-hours” services were provided, when infact services were provided during normal business hours.COMMONWEALTH V. COLEMAN FLOYDREMEDIES, INC.On August 4, 2009, a Grand Jury sitting in the City ofNorfolk, Virginia, indicted Coleman Floyd (Floyd) on fourcounts of Medicaid Fraud (Va. Code § 32.1-314). Floyd andhis wife are the owners of Remedies, Inc., a durable medicalequipment company operating in Norfolk. Remediescame to the attention of DMAS during a September 2006audit of the company. The audit indicated that Floyd wasbilling for adult size diapers and briefs when pediatricdiapers were being supplied. The MFCU’s investigationshowed Floyd took deliberate steps to upcode productssupplied to his clients. The alleged loss to the VirginiaMedicaid Program was $250,431.80. On December 2,2009, in the Circuit Court for the City of Norfolk, Floydpled guilty to four counts of Medicaid fraud, in violationof Va. Code § 32.1-314. Pursuant to a plea agreement,Floyd was sentenced to 12 years in the Department ofCorrections with 11 years suspended, giving him a totalactive sentence of 12 months to be followed by a term of12 years of supervised probation. Additionally, Floyd wasordered to pay $250,431.80 in restitution to Medicaidand will be barred from participating as a health careprovider.11

COMMONWEALTH V. JAMES WILLIAM WRIGHTNHC HealthcareOn August 25, 2009, James William Wright (Wright)was indicted for four counts of Aggravated SexualBattery, in violation of Va. Code § 18.2-67.3, in connectionwith his employment at NHC Healthcare (NHC), a nursingfacility in Bristol, Virginia. Wright was employed as aCertified Nursing Assistant (CNA) with NHC from 1999 to2007. MFCU investigators uncovered multiple incidentsof sexual misconduct involving Wright and elderly NHCresidents. MFCU investigators were able to substantiateallegations of misconduct, identify eyewitnesses toWright’s conduct, and obtain an admission of misconductfrom Wright himself. Wright sexually molestedelderly residents under his care while employed withNHC. On January 7, 2010, Wright entered an Alford guiltyplea to four counts of aggravated sexual battery, in violationof Va. Code §18.2-67.3. On May 14, 2010, in CircuitCourt for the City of Bristol, Wright was sentenced toserve 80 years with 20 years suspended (20 years withfive years suspended on each charge) or 60 years’ activeincarceration for committing aggravated sexual batteryagainst four elderly residents at NHC-Bristol. In addition,Wright was ordered to pay a $10,000 fine for each of thefour counts (a total of $40,000), will be placed on probationupon release, and will be required to register as a sexoffender.COMMONWEALTH V. JOANN WILLIAMSOn September 15, 2009, the Court of Appeals ofVirginia affirmed Joann Williams’ (Williams) convictionfor felony neglect of an incapacitated adult (Va. Code §18.2-369). Williams was convicted in the Prince WilliamCounty Circuit Court in Manassas, Virginia on January 7and 8, 2008. On appeal, Williams argued she was not the“responsible party” under statute and that her conductwas not knowing and willful neglect. Williams was aPersonal Care Assistant who was responsible for the careof a 55 year old incapacitated adult. Paramedics foundher client in a recliner, with his shirt soaked in drool andhis shorts soaked in urine. His legs were swollen andhad untreated sores. When his discolored socks wereremoved, the paramedics found each foot was infestedwith hundreds of maggots. He didnot appear to have been cleaned orbathed recently and the apartmentwas “very unsanitary,” with catfeces, dirty dishes and trash in thekitchen. The client was unable towalk or speak and was transportedto a local hospital and, due to hisextremely poor hygienic condition,he had to be decontaminated priorto treatment. In addition to problemsnoted by paramedics, thedoctor found a large decubitus ulcer in the sacrum thathad been developing for at least one month. Culturesfrom the examination established that the client haddeveloped a heavy bacterial infection involving staphaureus involving the coccyx, right leg, and foot. He washospitalized for a week and then discharged to a skillednursing facility. The client died of Amyotrophic LateralSclerosis (ALS) (also known as “Lou Gerhig’s Disease”)complications in hospice a month later. The evidenceat trial also established that Williams was paid to takecare of the client, she was the only person that tookcare of him, and she had allegedly just cleaned him upthe morning he was found by paramedics. In affirmingher conviction, the Court found it was irrelevant thatthere were other “responsible persons”who may have also neglectedhim because the Commonwealthonly had to prove that Williamswas “a responsible person,” andthe Commonwealth had done so.The Court also found the evidenceestablished Williams was aware ofthe client’s condition and failed tocare or seek care for him, and thather failures constituted knowingand willful neglect.12

COMMONWEALTH V. KADIATU DIALLOPOTOMAC CENTER GENESIS ELDERCAREOn February 3, 2010, in the Arlington County CircuitCourt in a jury trial, Kadiatu Diallo (Diallo) was foundguilty of two counts of assault (Va. Code § 18.2-57).The jury sentenced Diallo to one day incarceration oneach count and a $2,500 fine on each count. Diallo wascharged with assault for throwing popcorn in a tauntingand bullying manner at a resident at Potomac Centerin Arlington. The patient was bedridden and sufferedfrom dementia. Diallo was a Certified Nursing Assistantresponsible for providing care for the patient.COMMONWEALTH V. LINDA SLUSS BISHOP, LPNMountain Regional Care Services, Inc.On June 23, 2009, Linda S. Bishop (Bishop ) wasindicted on one count of misdemeanor patient abuse(Va. Code § 18.2-369) by a Grand Jury in the Scott CountyCircuit Court, Scott County, Virginia. Bishop, a LicensedPractical Nurse, was employed by Mountain RegionalPersonal Care Services (MRPCS) in Duffield, Virginia, tocare for an incapacitated Medicaid recipient. MRPCSreported the alleged abuse and an investigation was initiated.A MFCU investigator interviewed Bishop at herhome. Bishop admitted to slapping the recipient outof frustration. The investigation did not reveal that therecipient suffered serious bodily injury as a result of theassault. Bishop pled no contest to misdemeanor Abuseof an Incapacitated Adult (Va. Code § 18.2-369) andwas sentenced on Monday, October 5th, 2009 in ScottCounty Circuit Court to 30 days in jail (suspended) and24 months unsupervised probation (12 months withgood behavior) to include an agreement not to performhome health care. Ms. Bishop was also ordered to pay allcourt fines/costs within the next 6 months.Members of the Unit and others meet with Attorney General Kenneth T. Cuccinelli, II.13

APPEALSUNITED STATES V. MOHAMED A. ABDELSHAFI592 F.3d 602 (4th Cir. 2010).Mohamed A. Abdelshafi (Abdelshafi) was convictedin federal district court on fifteen counts of health carefraud, in violation of 18 U.S.C. § 1347, and two countsof aggravated identity theft, in violation of 18 U.S.C. §1028A. Abdelshafi, who owned and operated a medicaltransportation company, executed a scheme to defrauda Virginia Medicaid HMO by submitting: inflated reimbursementclaims that reflected more miles than actuallytraveled and reimbursement claims for trips thatnever occurred. Abdelshafi’s use of Medicaid recipient’snames, dates of births, and Medicaid identification numberson the fraudulent claim forms to establish legitimacyfor the claims formed the basis for the charges ofaggravated identity theft. On appeal, Abdelshafi contendedthat he could not be convicted of aggravatedidentity theft because he did not steal the patient identifiershe used on claims for reimbursement; and thathis sentence on the health care fraud counts shouldbe vacated because he should not have received anenhancement for abusing a position of trust. The FourthCircuit Court of Appeals, relying on the plain languageof the statute, affirmed Abdelshafi’s convictions holdingthat Abdelshafi’s conduct fell within the purview of theaggravated identity theft statute. The Court determinedthat nothing within the plain language of the statuterequired that Abdelshafi steal the personal patient identifiershe used on his fraudulent claim submissions. TheCourt further ruled that the sentencing enhancement forabuse of a position of trust was correctly applied by theDistrict Court.The Commonwealth of Virginia’s Wall of Honor honoring its Heroes who have diedserving in the Global War on Terrorism. This touching tribute is housed in the Officeof the Attorney General located in the Pocahontas Building in downtown Richmond.14

DETAILED CASE SUMMARYCriminalJuly 1, 2009 – June 30, 2010Category Carried Over Opened Closed PendingInstitutionsNursing Facilities 1 0 0 1Hospitals 0 0 0 0Other Institutions 1 0 0 1PractitionersMD/OD 4 2 2 4Dentists 1 0 1 0Podiatrists 1 0 0 1Psychiatrist/Psychologist 4 3 0 7Other 0 0 0 0Medical SupportPharmacy 0 1 0 1Durable Medical Equipment 5 0 3 2Laboratories 0 0 0 0Medical Transportation 4 0 1 3Home Health Agencies 8 15 5 18Rehabilitation Therapists 0 0 0 0Other 4 2 2 4Patient Abuse and NeglectPatient Abuse 2 2 1 3Corporate Neglect 5 3 4 4Patient FundsPatient Funds 2 1 1 2Total 42 29 20 5115

CIVIL CASESBEST PRICE FRAUD: AVENTIS SETTLEMENTIf a pharmaceutical company wants to be able toparticipate in the Medicaid program, the company mustagree to report to the government their “best prices” forsales of their drugs to retail, for-profit customers. Thecompany must rebate to state Medicaid programs thedifference between the price initially charged Medicaidfor their drugs and their Best Price (BP) for the drugduring each year. If the drug company fails to report discountsor other payments offered to pharmacies or otherproviders, this failure could improperly reduce the rebateowed to a state’s Medicaid program by millions as illustratedby the settlement with Aventis Pharmaceuticals,Inc. (API).API entered into a settlement agreement with theUnited States, Virginia, and other states to resolve claimsin several qui tam cases filed in the United States DistrictCourt for the District of Massachusetts that alleged APIcommitted BP fraud. The allegations concerned threedrugs: Azamacort (triamcinolone acetonide), a steroidbased anti-inflammatory nasal spray which prevents therelease of substances in the body that cause inflammationand is used to prevent asthma attacks; Nasacortand Nasacort AQ (triamcinolone nasal), nasal spraysthat are used for the relief of seasonal and year-roundnasal allergy symptoms in adults and children as youngas 2 years. All three drugs were manufactured andmarketed by API and its predecessor, Rhône-PoulencRorer Pharmaceuticals, Inc. (collectively referred to asAPI). API entered into private label sales contracts withother health care providers and sold the drugs to themat discounted prices and placed them in special packagingsubmitted for rebates under the other provider’sNational Drug Codes (NDC) instead of API’s NDCs. API’sfailure to report the discounted prices caused the statesto receive lower rebates than they would have receivedif the discounts had been reported. By failing to includethe discounts, API knowingly made false statements todecrease its obligations for payment to the MedicaidProgram in violation of federal and state False Claimsstatutes. The settlement resolves false claims submittedby API from October 1, 1995 through September 30,2000, during which time API reported to the Centers forMedicare and Medicaid Services (CMS) false BPs to avoidpaying higher quarterly drug rebates to the states forAzamacort, Nasacort and Nasacort AQ.Under the settlement agreement, API paid$89,007,824 plus interest to settle potential federal andstate claims, from which the United States received$48,954,303, and the remaining $40,053,521 was distributedto the states. Virginia’s state and federal share of thesettlement was $1,626,759.14. The Virginia Departmentof Medical Assistance Services received the state share ofthe settlement plus interest in the amount of $818,432.84in November, 2009.CIVIL UNIT16Members of MFCU’s Civil Unit include: (clockwise starting at the rearleft) Erica Bailey, Michele Stanley, Bobby Powell, Kristy Knighton, RandyDavis, Angela Axselle, Mike Judge, Clay Garrett, Candice Hooper, Lelia Beck,Latarsha Tyler, and Tracey Sanders.

OFF-LABEL MARKETING AND KICKBACKS: PFIZER SETTLEMENTTwo common healthcare fraud schemes that healthcare fraud investigators encounter are off-label marketingand kickbacks. The two schemes are not onlycommon, but often are used simultaneously toward thesame end – increasing or maintaining market share. Offlabelmarketing occurs when a company publishes informationconcerning a drug product that is false, unsubstantiatedor not supported by the drug’s FDA-approvedlabel. Although a doctor is free to prescribe a drug foran off-label use, a pharmaceutical company is prohibitedfrom marketing a drug for off-label uses. See 21 U.S.C. §331 (2007). The federal Anti-Kickback Statute, 42 U.S.C.§ 1320-7b (b), bars transactions intended to encouragepatient referrals or other business, or to compensateother parties for making those referrals using federalfunds. Examples of illegal kickbacks may involve paidremuneration to physicians through speaker programs,preceptorship agreements, tutorials, and focus groupsto reward physicians for writing prescriptions for acompany’s drugs. The investigation into the complaintsregarding Pfizer that led to a settlement last year demonstrateshow a pharmaceutical company may use off-labelmarketing and kickbacks toward the same end.The Virginia MFCU assisted the National Associationof Medicaid Fraud Control Units’ Negotiating Team(NAMFCU) in negotiating a settlement following an investigationof off-label marketing and kickbacks by Pfizer,Inc. The civil settlement resolved fraud claims raised inseven qui tam cases filed in United States District Courtsfor the District of Massachusetts, the Eastern District ofPennsylvania, and the Eastern District of Kentucky. Thefalse claims involved off-label marketing and kickbackschemes used by Pfizer to promote the sales of Bextra,Lyrica, Geodon, and Zyvox; and kickback schemes toincrease sales of Aricept, Celebrex, Lipitor, Norvasc,Relpax, Viagra, Zithromax, Zoloft and Zyrtec. Under thesettlement agreement, Pfizer paid $1 billion plus interestto settle the civil claims in this case. Approximately $705million of that amount was set aside for state Medicaiddamages and penalties.The settlement covered false claims submitted tostate Medicaid programs for reimbursement of Bextra,Geodon, Lyrica, and Zyvox prescriptions, which werecaused by improper off-label marketing and kickbackschemes. The settlement also included reimbursementsof Aricept, Celebrex, Lipitor, Norvasc, Relpax, Viagra,Zithromax, Zoloft and Zyrtec prescriptions that werecaused by unlawful kickbacks. A large portion of the civilsettlement and the criminal plea were based on Pfizer’soff-label marketing of Bextra, Geodon, Lyrica, and Zyvox.Under the terms of the settlement agreement, theUnited States received approximately $668.4 millionof the civil settlement. The remaining $331.4 millionwas distributed to the states. Virginia’s total federaland state Medicaid damages were $11,887,143.19, ofwhich $5,645,383.26 represents the federal share and$6,455,679.69 represents the amount paid to the VirginiaDepartment of Medical Assistance Services under thesettlement agreement.As part of the settlement of the off-label marketingclaims for Bextra, Pfizer’s subsidiary Pharmacia & UpjohnCompany pled guilty to a felony Information filed inthe United States District Court for the Eastern Districtof Massachusetts. The Information charged Pharmaciawith one-count of misbranding in violation of 21 U.S.C.§§ 331(a), 331(a)(1) and 335(f)(1) in that Pfizer marketedBextra for treatment of non-FDA approved medical conditions.As part of its plea agreement, Pfizer agreed topay record criminal fines and forfeitures of $1.3 billion.The total state and federal civil and criminal resolution-- $2.3 billion -- represents the largest recovery in a healthcare fraud investigation in United States history.18

DETAILED CASE SUMMARYCivilJuly 1, 2009 – June 30, 2010Category Carried Over Opened Closed PendingInstitutionsNursing Facilities 1 0 1 0Hospitals 2 1 2 1Other Institutions 0 0 0 0PractitionersMD/OD 0 1 0 1Dentists 1 0 0 1Podiatrists 0 0 0 0Psychiatrist/Psychologist 0 0 0 0Other 2 0 0 2Medical SupportDurable Medical Equipment 8 8 1 15Laboratories 4 6 0 10Pharmaceutical Companies 122 60 26 156Transportation 0 0 0 0Home Health 2 0 0 2Rehabilitation Therapists 0 0 0 0Other 4 3 0 7Patient Abuse and NeglectCorporate Neglect 0 1 0 1Total 146 80 30 19619

CASE ACTIVITY SUMMARYThe following is a brief statistical summary of cases investigated fromJuly 1, 2009 – June 30, 2010CasesCases carried over 188Cases opened Criminal 29Civil 80Total 109Cases Closed With criminal resolution 8With civil resolution 8Insufficient evidence/no further action 34Total 50Indicted cases pending (7/1/2009) 5Total cases pending (criminal and civil) 247Criminal Prosecution/RecoveryIndictments (individuals) 22Convictions 13Dismissed 1Acquittals 1Total length of probation940 monthsTotal incarceration time2433 monthsTotal suspended incarceration time2053 monthsTotal hours of community service0 hoursProviders terminated from program upon conviction 13Ordered restitutions, reimbursements, criminal fines and interest $826,580.16Civil Recovery - including Affirmative Civil Enforcement (ACE)Settlements/reimbursements received $24,563,887.05Investigative costs received $0Total $25,390,467.2120

ELDER ABUSE AND NEGLECT SQUADThe Elder Abuse and Neglect Unit of the VirginiaAttorney General’s Medicaid Fraud Control Unit (MFCU)investigates allegations of abuse or neglect of elderlyand incapacitated adults receiving Medicaid benefits inthe Commonwealth. To keep up with a large caseload,two investigators and three nurse investigators will beadded to the Unit after July 1, 2010 for a total staff of tenand the Chief. As a result of this networking effort, collegialrelationships have developed between the MFCUand the various agencies, and referrals are arriving at arapid pace. The Elder Abuse and Neglect Unit strives toensure rapid response to referrals, effective investigations,and successful outcomes that will ensure Virginia’svulnerable adults receive the highest quality of care possiblein both home and institutional settings.Unit Program Coordinator Patricia Cooper-Lewisand Attorney General Kenneth T. Cuccinelli, II.Paralegal Kimberly Wilborn and AdministrativeCoordinator Hamilton Roye.21

UNIT PROJECTIONSThe MFCU has an outstanding working relationshipwith state, local and federal agencies. Some of thekey partner agencies are the Department of MedicalAssistance Services’, the Offices of the United StatesAttorney for the Eastern and Western Districts ofVirginia, the Federal Bureau of Investigations, Health andHuman Services’ Office of Inspector General, InternalRevenue Services’ Criminal Investigation Division, theVirginia Department of Health Professions, the VirginiaDepartment of Health, the Virginia Department of SocialServices, and local law enforcement. Attorney GeneralKenneth T. Cuccinelli’s and former Attorney General BillMims’ approach to the investigation of major fraud cases,in conjunction with other state, local, and federal agencies,contributed to the positive results obtained by theUnit last year.At the end of the 2009-2010 reporting year, theUnit had 51 active criminal investigations of healthcareproviders located throughout the Commonwealth. Inaddition, 22 have been indicted and were awaiting trialor sentencing in federal court. The Civil InvestigationsSquad had opened 80 new civil cases.The Unit will continue to participate in joint federaland state task forces to investigate and developcomplex cases dealing with provider fraud in the feefor-servicecommunity and the institutional neglectcases of patients in nursing homes. The Unit will alsocontinue to work closely with the Offices of the UnitedStates Attorney for the Eastern and Western Districts ofVirginia, and the Affirmative Civil Enforcement Programto pursue Medicaid providers through the Federal FalseClaims Act and the Virginia Fraud Against Taxpayers Act.During state fiscal year 2010-2011, the Unit projects thatthe investigative, prosecutive, and civil recovery effortsof the Unit will result in 16 convictions, with combinedcriminal and civil recoveries of more than $30,000,000.V I R G I N I A A T T O R N E YG E N E R A L ’ S O F F I C ES P E C I A L P O I N T SO F I N T E R E S T :• Services• Case SpotlightI N S I D E T H I SI S S U E :Types of MedicaidBenefitsWho is eligiblefor MedicaidWhere to reportMedicaid fraudWhere to reportrecipient fraudVirginia Medicaid Fraud Control UnitV O L U M E 1 , I S S U E 2What Services are Provided Under MedicaidDid you know thatindividual statesdetermine what theirrespective Medicaidplans provide.However, there aresome mandatory federalrequirements that statesmust meet in order toreceive federal fundingmatches. Thoserequired servicesinclude:• Inpatient hospitalservices• Physician services• Nurse-midwifeservices• Nursing facility servicesfor persons aged 21 orolder• Vaccines for children• Prenatalcare• Outpatienthospitalservices• Pediatric andfamily nurse practitionerservices• Home health care forpersons eligible for skillednursing services• Rural health clinic services• Laboratory and x-rayservices• Federally qualified healthcenter(FQHC) servicesand ambulatory services• Family planning servicesand supplies• Early and periodicscreening, diagnostic,and treatmentJ U N E 2 0 1 0services for childrenunder age 21States may alsoprovide optionalservices such as:• Transportationservices• Home and community-basedcare to certainpersons withchronic impairments• Diagnostic services• Prescribed drugs andprosthetic devicesIf you suspect that Medicaid fraud or abuse, neglect orexploitation has occurred in a Medicaid facility or hasbeen committed by someone working for a Medicaidprovider, immediately report the incident to theMedicaid Fraud Control Unit (MFCU) of the Office ofthe Virginia Attorney General at 1-800-371-0824 or804-371-0779.22In 2010, the MFCU began publishing a quarterly Newsletter that includes recentcases, tips, fact sheets and other pertinent information on Medicaid fraud andelder and patient abuse and neglect.

PROJECTIONS FOR 2010-2011 FISCAL YEARCategory Closed PendingInstitutionsElder Abuse 3 8Nursing Homes/Corporate Neglect 1 4Hospitals 2 0Home Health Agencies 7 3PractitionersDentists 0 0Doctors 2 2Psychiatrist/Psychologist 3 2Other 10 10Medical SupportDurable Medical Equipment 11 5Laboratories 5 2Pharmacies/Pharmaceuticals 80 25Medicaid Transportation 3 0Rehabilitation Therapists 5 0Total 132 61Projected Criminal and Civil Recoveries $30,000,000Projected Criminal Convictions and Civil Recoveries 1623

UNIT PERFORMANCEIn 1982, the United States Department of Health and Human Services certifiedthe Virginia MFCU as the nation’s thirty-first Medicaid Fraud Control Unit. Over thepast twenty-eight years, the Virginia MFCU has been responsible for the successfulprosecution of over 263 providers in cases that involved patient abuse and neglect orthe commission of fraudulent acts against the Virginia Medicaid program. In addition toprosecuting those responsible for healthcare fraud and/or abuse, the Unit has recovered$780,977,738.21 in criminal restitution, asset forfeiture, civil judgments, and settlements.The Medicaid Fraud Control Unit was extremely successful in fiscal year 2009-2010,particularly through its participation in multi-agency investigations. The Unit ended thefiscal year with 13 convictions and total recoveries from criminal and civil investigationsof $25,390,467.21.Three Year Recovery StatisticsPer MFCU EmployeeMFCU recovered an average of $198,032,584.74 per year over the past threeyears. The MFCU has averaged 48 staff members per year over the past threeyears. The recovery average per filled MFCU position for the past three years is$4,124,678.85 per person.24Section Chief for MFCU Steve Buck, Chief Prosecutor David Tooker, andAssistant Attorney General Eric Atkinson.

UNIT ACTIVITIES/EXPANSIONSocial Security Task Force. The MFCU continues toparticipate in a pilot project with the Social SecurityAdministration that investigates allegations of disabilityfraud involving the Social Security and Medicaidprograms. This program began in 2003 and has beensuccessful in its ongoing mission. The Social SecurityAdministration pays all costs incurred by the MFCU,including salaries, benefits, and investigative costs. Bypreventing unqualified persons from receiving SocialSecurity disability benefits, the Task Force saves theexpenditure of unwarranted Medicaid funds. The TaskForce finished the year with a five-year projected savingsof over $8.6 million to the Virginia Medicaid program.Unit Growth. In the last fiscal year, the Unit receivedapproval to hire 25 additional personnel to more effectivelyinvestigate allegations of fraud in the VirginiaMedicaid program and pharmaceutical industry, aswell as complaints of elder abuse and neglect in nursinghomes. The MFCU has also taken a leading role ina multi-state case which should come to fruition in thenext 6-9 months. Further, the MFCU’s community outreachhas begun and we have already seen an increasein referrals of fraud.The MFCU Director has continued to serve on theDepartment of Health Professions Prescription DrugMonitoring Board and this year was re-elected Vice-Chairman. The MFCU Director is a member of NAMFCU’sGlobal Case committee as well as the PerformanceStandards Working Committee. Finally, the MFCU Directoris Co-Chairman of NAMFCU’s Personnel Committee.During the fiscal year, the MFCU provided trainingsessions and presentations. The topics ranged fromMedicaid fraud to patient abuse and neglect.As part of MFCU’s outreach efforts, the Unit developeda new brochure and quarterly newsletter. Letterswere sent to every police chief and sheriff across theCommonwealth with copies of the brochure and newsletterand information on available Medicaid fraudawareness training for their departments and theircommunities.A Deputy Director of the MFCU continues to serveas a member of the NAMFCU Training Committee. He isan instructor at both the Introductory and Practical SkillsNAMFCU Medicaid Fraud Training programs.Our Chief of the Elder Abuse and Neglect Squadserves on the Advisory Board of the Virginia SeniorMedicare/Medicaid Patrol Project, for which the VirginiaAssociation of Area Agencies on Aging received a threeyeargrant from the Administration of Aging. The intentof the project is to provide a Senior Fraud Patrol of volunteerprofessional retirees trained to identify Medicareand Medicaid fraud. The members of this group areavailable to provide presentations regarding Medicareand Medicaid fraud in their communities. The Chief alsosits on the Education Committee for the National AdultProtective Services Association.Paul Anderson, Deputy Director of Investigations and Audits.25

ANNUAL CASE ACTIVITY SUMMARYFiscal Years 1982 through 2009Total Criminal and Civil Recoveries,including Affirmative Civil Enforcement Cases(Ordered and Collected Reimbursements, Fines, Restitutions)Fiscal YearTotal RecoveriesJuly 82 - June 83 $5,600.00July 83 - June 84 $19,600.00July 84 - June 85 $15,300.00July 85 - June 86 $13,522.00July 86 - June 87 $82,136.00July 87 - June 88 $114,443.00July 88 - June 89 $237,583.00July 89 - June 90 $322,547.00July 90 - June 91 $312,207.00July 91 - June 92 $205,370.00July 92 - June 93 $387,064.00July 93 - June 94 $416,966.00July 94 - June 95 $400,280.00July 95 - June 96 $1,281,129.00July 96 - June 97 $2,275,542.00July 97 - June 98 $1,053,099.00July 98 - June 99 $2,577,045.00July 99 - June 00 $1,480,345.00July 00 - June 01 $37,612.00July 01 - June 02 $12,081,532.00July 02 - June 03 $11,848,871.00July 03 - June 04 $14,358,790.00July 04 - June 05 $10,578,111.00July 05 - June 06 $9,071,043.00July 06 - June 07 $117,704,247.00July 07 - June 08 $541,099,617.00July 08 - June 09 $27,607,670.00July 09 - June 10 $25,390,467.21Total: $780,977,738.2126

THREE-YEAR AVERAGE RECOVEREDPer Number of Staff (per year)Reporting Periods Total Number of Employees Number of Employees –Three Year AverageJuly 1, 2007-June 30, 2008 44July 1, 2008-June 30, 2009 49July 1, 2009-June 30, 2010 52 48Three-Year Recovery Average Number of MFCU Staff- Three-Year Average Recovered(per year) Three Year Average Per Position (per year)$198,032,584.74 48 $4,125,678.85recovered per staffed positionThe three-year (2007–2009) recovery average forthe Virginia MFCU is $198,032,584.74 per year.PROPOSED 2010-2011 BUDGETPersonnel Expenses $7,151,478.60Non-Personnel Expenses $1,287,441.25Indirect Costs $1,303,356.98Total Proposed Budget $9,742,276.8327

PROPOSED 2010-2011 BUDGETCategoryBudgeted AmountPersonnel ExpensesA. Salaries $5,434,832.08B. Benefits $1,716,646.52Personnel Expense Total $7,151,478.60Non-Personnel ExpensesA. Travel $ 469,201.25B. Equipment/Improvements $ 45,740.00C. Special Payments $ 0.00D. Supplies and Materials $ 41,000.00E. Contractual Expenses $ 626,000.00F. Other Expenses $ 105,500.00Non-Personnel Expense Total $1,287,442.25Indirect Cost (24.3%)Indirect Cost Total $1,303,356.98Grand Total $9,742,276.83Salaries $5,434,832.08Benefits $1,716,646.52Personnel Expenses $7,151,478.60Travel $ 469,201.25Equipment/Improvements $ 45,740.00Special Payments $ 0.00Supplies and Materials $ 41,000.00Contractural Expenses $ 626,000.00Other Expenses $ 105,500.00Non-Personnel Expenses $1,287,442.2528

2009-2010 EXPENDITURESJuly 1, 2009 – June 30, 2010NON-GENERAL FUND/PURDUE $1,337,542.76FEDERAL GRANT $3,705,342.64INDIRECT COSTS $ 697,213.47TOTAL $5,740,098.87$1,337,542.76AppropriatedNon-General FundTotal:$5,740,098.87$3,705,342.64Federal Grant$697,213.47Indirect Costs29

TRAININGThe Unit is committed to an aggressive training program for all staff members as ameans of improving knowledge and skills in order ensure the highest quality investigationsand prosecutions.In order to achieve and maintain a high level of productivity from all staff members,training and continuing education have been built into staff development. Staff haveparticipated in programs selected to meet their individual and professional requirements,as well as to meet the needs of the Unit. The following are brief descriptionsof training programs attended by MFCU staff. A chart indicating dates and staff thatattended is also included in this report.MFCU staff also provided training to various groups. A description of those presentationsas well as a chart of dates and presenters follows.30

TRAINING PROVIDEDIntroduction to Medicaid Fraud – 101 Training. Assisted withproviding attendees training on medical records/ healthcare terminology; overview of MFCU program; workingwith claims data; fraud in institutional settings and financialabuse of patients; managed care; provider fraudschemes; practical exercise; medicaid fraud case studies;preparing cases for prosecution; overview of residentabuse investigative techniques.Medicaid Fraud Control Unit’s In-House Training. Topicsincluded review of administrative, training and outreachmatters; review of travel regulations; significant cases;federal forfeiture; Jencks and Giglio cases; DependableHome Health Care; role of ppl within DMAS; granny camsand the law; represented parties; case management andservice facilitation; and case reviews.Medicaid Fraud Investigation. Spoke about the history ofMedicaid and why Medicaid Fraud Control Units werestarted in 1977 by Congress. Discussed different types ofMedicaid fraud and what the Virginia MFCU investigates.Talked about our main office in Richmond and the satelliteoffices and work throughout the Commonwealth.Medicaid Fraud Control Unit – Overview – Before the VirginiaAssociation of Personal Care Providers Ninth Annual Conference.Overview of the MFCU, the elements of health care fraud,and examples of fraudulent activities normally found ina personal care provider fraud case. Additionally, a caseexample was provided and discussed. Lastly, MFCU contactinformation was provided. Audience consisted ofMedicaid providers of personal care.Director Randy Clouse provides an overview of the MFCU to the Attorney General’s Office’s summer legal interns.31

DATES AND PERSONNEL PROVIDING TRAININGDate Program Personnel7/28-31/09 NAMFCU Practical Skills Program One Deputy Director9/16/09 Medicaid Fraud Investigation One Criminal Investigator10/27-29/09 Introduction to Medicaid Fraud – 101 Training One Deputy Director11/19/09 Virginia Association of Personal Care Ninth Annual One Chief InvestigatorConference – Overview of MFCU1/11-14/10 MFCU In-House Training One ManagerTwo Deputy DirectorsOne DirectorOne Assistant Attorney GeneralOne Chief of Criminal InvestigationsOne Nurse InvestigatorOne Chief Counsel and Section Chief2/23-25/10 Introduction to Medicaid Fraud – 101 Training One Deputy DirectorThe Virginia Attorney General’s Office hosts a statewide campaign in the legalcommunity to collect food for the poor known as the Legal Food Frenzy.32

TRAINING RECEIVEDA Day in Discovery–Win Your Case Before Trial (Virginia CLE).Provided information to litigators who spend more timein discovery and case preparation than almost anythingelse and provides them with an organized systemapproach. Covered the basicsbut also provided innovativeand challenging techniquesthat can help even the mostexperienced practitioners.Adobe Tips and Tricks. Providedinformation on PDF creation,search, annotations and comments,working with PDFs andweb.Alternative Dispute Resolution (ADR). A presentation oneffective use of ADR. The presentation identified relevantterms and concepts as well as procedural guidancefor the utilization of ADR.American Bar Association’s Annual Litigation Institute for TrialTraining. Topics included review of opening statements,examination of witnesses, jury selection, direct and crossexamination, closing arguments, building themes andthe art of persuasion.American Bar Association’s Anti-Kickback Law BasicsTeleconference. Provided attorneys information on thehistory and purpose of the anti-kickback statute, how toapply it, and comparison of the anti-kickback statute toother fraud and abuse laws. The course enhanced theattorneys’ abilities to investigate and prosecute the casesassigned to the MFCU.American Bar Association’s Health Care Fraud Conference.Topics included foundations of health law and healthcare reform, foundations of white collar law and practiceand handling a health care fraud case, health care reform,and health care fraud enforcement.American Bar Association’s Institute on White Collar Crime.Topics included sentencing in white collar criminal caseand witness/victim rights, trying cases in the post-Madofflandscape, corporate charging decisions, obstruction ofjustice and making false statements, and rising trends inhealth care fraud enforcement.Before you Take the Plunge – What you Need to Know aboutPatent, Copyright and Trademark Costs. Session covereddemonstrative evidence and electronic presentation ofexhibits at trial.California District Attorneys Association’s Elder AbuseSymposium. Topics included training in elder medicalissues, medical evidence and experts, interagency cooperationin prosecuting elder abuse cases, and cooperationbetween social workers and law enforcement,among other topics.Case Generation: Medicare Fraud Strike Force (MFSF) andProjects to Deter Health Care Fraud. Topics included developinginnovative enforcement solutions, evaluating anddeveloping policies and strategies for program integritysafeguards, and educating federal agents and attorneyson legal development in the areas of fraud and abuseenforcement.Civil Discovery Institute. Provided acomprehensive look at civil discoveryissues to enhance practice skillsand develop strategies. The seminarfocused on the most significantissues in civil discovery, including:an important update on civil discoveryissues, provided an opportunityto network and hear from experiencedfaculty of trial practitioners,in-house counsel, and judges, andprovided sample forms and briefs.Clearwell/Document Management Training. Topics includedinformation on Clearwell System and managing legal,regulatory, and investigative matters, and interagencydata analysis. Covered how to accelerate documentprocessing.Criminal E-Discovery. Presentation on most commonissues and best practices surrounding E-Discovery.Crime Victims’ Rights Act Presentation. Presentation providedthrough the Virginia State Bar on rights andresponsibilities of crime victims and witnesses under theCrime Victim and Witness Rights Act and related laws.33

TRAINING RECEIVEDCyber Security Awareness Training. Training on cyber security,scareware, strong passwords, protecting your computer,recognizing and avoiding spyware, protectingyour privacy, avoiding social engineering and phishingattacks, guidelines for information security and Internetusage, securing a wireless network and other mattersdealing with cyber security.Department of Medical Assistance Services Cost ReportTraining. Training provided prosecutors and agents informationon how health care institutions that bill bothMedicaid and Medicare can commit health care fraud byfalsifying reports.Department of Medical Assistance Services Pharmacy andPreferred Drug List Program. Provided overview of Medicaiddrug rebate program, pharmacy claims processing, specialclaims processing procedures, Mandatory GenericProgram, Maximum Allowable Cost Program, SpecialtyMaximum Allowable Cost Program, ProDUR Programupdate, over the counter medications, Medicare Part DPrescription Drug Program, Preferred Drug List Program,miscellaneous pharmacy management information, andPreferred Drug List Program.Department of Medical Assistance Services SAS Users Group.Overview of changes in SAS file and system.Department of SocialServices APS Workers TeamMeeting. Provided informationon APS referralguidelines, what to refer,and what not to refer.Excel Training. Topicsincluded Excel training,sorting, subtotals, andpivot tables.Health Care Fraud. Topics included hospital cost reports,DME case preparation, organized crime in health carefraud, and durable medical equipment, prosthetics,orthotics, and supplies fraud.Health Care Fraud and Abuse: What you Need to Know. Topicsincluded overview of health care fraud from a defensestandpoint and recent amendments. Also, discussedkickbacks and overpayments as well as health carereform bill of 2010.How to Introduce Typical Trial Exhibits and Use Them Effectively.Topics included overview of trial exhibits and how to usethem effectively at trial, authentication, the hearsay rule,and the best evidence rule.“How Well Do Law Firms Handle Digital Information asEvidence?” Webinar. Topics included delivery of trulydefensible standards of care – collaborating with company’sIT, records management and information securityfunctions and improving and being accountable inmanaging digital information as evidence through disciplinedmethodology.Investigation and Discovery. Presentation included identifyingpotential witnesses and potential jurors. Informationto use when trying to serve a subpoena on an elusivewitness.John E. Reid: Interview and Interrogation Techniques. Trainingfeatured a discussion of three primary topics: behaviorsymptom analysis (the verbal and nonverbal behavioralcharacteristics which can be used to distinguish a truthfulperson from a deceptive individual), the BehaviorAnalysis Interview (a non-accusatory interview processutilizing both investigative and behavior provokingquestions); and, the Reid Nine Steps of Interrogation.John E. Reid: Lawyers’ Institute of Forensic Interviewing.Training provided attorneys a continuing educationprogram in advocacy, which adapts non-coercive criminalinterrogation methods for elicitation of informationwithin forensic setting of depositions, jury selection,direct/cross examination, and witness statements.Legal Research for Non-Lawyers; Case Law. Covered thestructure of both federal and state court systems, coursesof case law and how to find and validate case law.Lexis-Nexis Concordance. Overview of concordance fundamentalsand concordance administrative fundamentalsadministrative fundamentals.34

TRAINING RECEIVEDManaging a Large Document Review for Paralegals. Overviewof challenges regarding volume data, globalization ofdata sources, short time frames, limited budgets, confusingvariety of solutions, traditional vs. technical approach,how to estimate size of collection, planning the collectionproject, collection of documents, reducing scope ofa document collection, documenting the process, effectivemanagement, and shortened review timeframes.Master Lexis.com. Provided information on powerful toolsand proven techniques to help make research more efficientand cost effective.Medicaid Fraud Control Unit’s In-House Training. Topicsincluded review of administrative, training and outreachmatters, review of travel regulations, significant cases,federal forfeiture, Jencks and Giglio cases, DependableHome Health Care, role of ppl within DMAS, granny camsand the law, represented parties, case management andservice facilitation, and case reviews.National Adult Protective Services Association Conference.Provided information to enhance job skills and providedopportunities to exchange knowledge and ideaswith other professionals, addressed major concerns andissues related to elder/adult abuse and neglect, elevatedpublic awareness of abuse, neglect, and exploitation ofelderly persons and persons with disabilities, fosteredcollaboration among those who serve, treat, or representvictims of elder abuse.National Advocacy Center Conference: Federal PracticeSeminar. Provided new federal prosecutors the principlesgoverning the prosecution and trial of federal criminalcases. Lecture topics included drafting complaints,indictments, search warrants, grant jury practice pre-trialdiscovery and motion practice, the use of cooperatingdefendants, plea bargaining, evidence, federal sentencingguidelines, and asset forfeiture.National Advocacy Center Conference: Intermediate CriminalTrial Skills. Conference provided an intensive advocacyskills program designed for new federal prosecutors withprevious trial experience as a state court prosecutor orJudge Advocate General and who will be responsiblefor trial of criminal cases. Seminar utilized lectures, skillsexercises, critiques, and trial strategy sessions. Classroomand video critiquing was also utilized.National Advocacy Center Conference: Legal InformationTechnology for Attorneys Seminar. Course focused onproviding prosecutors with basic skills needed tomanage a case electronically from indictment/complaintto trial using software that is currently availableto all U.S. Attorneys Offices. The training covered IPRO,Concordance, CaseMap, TimeMap, PowerPoint, andSanction II.National Association of Medicaid Fraud Control Unit’s AnnualConference. Topics included review of national trendsand cases involving both Medicaid fraud and patientabuse.National Association of MedicaidFraud Control Unit’s Director’sSymposium. Topics included performancestandards, data miningby MFCUs, on-site visits, amendingthe MFCU federal regulations,training requirements forMFCUs federal funding grantissues, dialogue with NationalAssociation for Medicaid ProgramIntegrity and Medicaid IntegrityContractor’s representative,Medicaid and 340B programs andimplications of manufacturer miscalculations,Federal False ClaimsAmendment and DRA review, andglobal case training.National Association of Medicaid Fraud Control Unit’s GlobalCase Committee Meeting. Committee is responsible foroverseeing the appointment and staffing of settlementteams for government healthcare fraud cases impactingthe Medicaid program. The committee is also responsiblefor organizing and presenting training seminars forattorneys in the member states.National Association of Medicaid Fraud Control Unit’sIntroduction to Medicaid Fraud – 101 Training Program. Topicsincluded review of medical records/health care terminology,overview of MFCU program, working with claimsdata, fraud in institutional settings and financial abuse ofpatients, managed care, provider fraud schemes, practicalexercise, Medicaid fraud case studies, preparing casesfor prosecution, and overview of resident abuse investigativetechniques.35

TRAINING RECEIVEDNational Association of Medicaid Fraud Control Unit’sIntroduction to Medicaid Fraud – 102 Training Program.Training was designed for all Medicaid fraud investigatorsandprosecutors to attend training after garneringsignificant experiencein the MedicaidFraud Control Unit. TheMedicaid fraud federalgrant requires eachMFCU to meet certainperformance standards.One of the performancestandards is to demonstratethat each state’sMFCU fully and appropriately trains employees on howto investigate and prosecute Medicaid provider fraud.National Association of Medicaid Fraud Control Unit’sInvestigating and Settling Global Cases Training. Trainingis for NAMFCU Global Case Team members to providethem with guidance about issues pertaining specificallyto global case investigations, intervention and litigation.Training topics included: intake process, utilizationreview, relator’s interviews, and multi-agency coordination,building partnerships between NAMFCU teams,relators and the feds, panel of federal representatives,working with relators and DOJ, intervention/litigation,investigative plan, document organization, review andanalysis, and introduction to data analysis.National Health Care Anti-Fraud Association’s FundamentalsAcademy for Health Care Fraud Investigators Part 1 and 2.Examined the anatomy of an investigation. Investigatorsand law enforcement personnel learned how to do thefollowing: examine sources for health care fraud leads,assess the potential of a case, develop an investigativeplan, and utilized evidence-gathering techniquesfor both internal and external information. The facultyreviewed successful interviewing techniques, addressedelements of a good report, examined the steps to preparea case for prosecution, and discussed how toevaluate the evidence and determine the final action.Explored common health care fraud schemes includingupcoding, unbundling, doctor shopping, phantom billing,and common specialty area schemes. Faculty alsoexplored issues surrounding quality of care and unnecessarymedical procedures and discussed medical recordterminology and medical record review. Participantshad an opportunity to test their acquired skills throughan interactive case study.National Health Care Anti-Fraud Association’s Investigationand Management Seminar. Training provided managersand senior investigators, and law enforcement supervisorystaff an in-depth opportunity to discuss high-leveltopics and emerging trends specific to health care fraudinvestigation management. Explored leadership andcommunication skills to engage in peer to peer discussionon the best management strategies.National Health Care Anti-Fraud Association 2009 AnnualTraining Conference. Topics included developing patientsas witnesses, detecting deception, active listening skills,investigation of the year, match your investigationcapacity against the cases with the highest potential,Medicaid fraud control unit panel, emerging health carefraud schemes, dental fraud, health care fraud investigationsin the United Kingdom, grooming witnesses forcourt, reading the signs that someone is being untruthful,learning to listen as to what is really being said, frauddetection and investigations, anti-fraud technology andservices, legal, regulatory and management of cases,fraud detection and investigations in specialty areas,clinic issues of the health care fraud investigator, casereview, and fraud detection and investigations.36

TRAINING RECEIVEDNational Health Care Anti-Fraud Association Training Webinar.Topics included detecting deception and patient interviewingskills. Broke down the interviewing process toits basic core concepts and discussed how to apply thesetechniques to expose medical fraud and abuse throughpatient interviews. Learned how to identify the manyways witnesses use evasive and deceptive responses toavoid answering questions, listen for indirect admissionsand expose deception during witness interviews.National Institute on Healthcare Fraud 20th Annual Conference.Topics included coverage of foundations of health lawand health care reform, foundations of white collarlaw and practice and handling a health care fraud case,health care reform and health care fraud enforcement,government enforcement panel, fraud enforcement andrecovery act and false claims act developments, negotiatingcorporate integrity agreements, state enforcementand Medicaid fraud, pharmaceutical and medicaldevice fraud and abuse, criminal and civil enforcementof anti-kickback statute, negotiating complex civil settlements,trial practice demonstration, federal sentencingguidelines and criminal and civil damage, affirmativeresponses to government investigations, grand juryinvestigations, search warrants and subpoenas, the roleof compliance officers, general counsel and managementand the board, litigating false claims act cases,workshop for defense and in-house counsel, workshopfor government counsel, workshop for qui tam/relators’and other plaintiff’s counsel, voluntary disclosure andcooperation in government investigations, and ethicalissues in criminal and civil fraud cases.Office of Inspector General, U.S. Department of Healthand Human Service’s Administrative Training Conference.Provided guidance to state MFCU management personneland agency administrative staff on issues and concernsthat relate directly to the oversight responsibilitiesof the HHS-OIG, MFOD federal oversight role, federalreporting requirements, and budget administration.Pressure Ulcer Management: Clinical and Legal CompetenceCourse. Training addressed critical issues in wound carethat is relevant to investigations in the Elder AbuseSquad. Provided eight risk factors for the developmentof pressure ulcers, identified three lab tests relevant tothe management of patients with pressure ulcers, examinedhow to appropriately stage/classify pressure ulcers.Professional Responsibility CLEon JTN: A Prosecutor’s DisclosureObligations. Session focused oninterplay of Model 3.8(d), ABAModel Rules of ProfessionalConduct and Brady/Giglioissues.SAS Programming Introduction:Basic Concepts Course.Provided training on planningand writing sample SASprograms to solve commondata analysis problems, creatingsimple list and summaryreports, defining new datacolumns (variables), executingconditional code, and navigating through the SAS windowsenvironment.Taxpayers Against Fraud (TAF) Conference. TAF is a national,nonprofit, public interest organization comprisedmainly of relator’s attorneys who assist in combatingfraud against federal and state governments throughthe promotion and use of the Federal False Claims Act.Conference provided an opportunity for federal andstate government attorneys to learn from relator’s attorneysthat Virginia MFCU works closely with in qui tamcases.The Power of PowerPoint for Paralegals: Creating an EffectiveTrial Presentation. Training focused on training for paralegalsto assist the attorneys and investigators in both civiland criminal cases and PowerPoint presentations thatare occasionally required.37

TRAINING RECEIVEDUnited States Attorney’s Office’s Client Privilege Training.Topics included ethical duties of lawyers with respect toprivilege, applicable statutes and ABA Model Rules, andthe common issues and practical tips surrounding attorney-clientprivilege.United States Department of Justice’s Office of Legal EducationEvidence for Criminal Litigators, Part 8. Topics includedsharpening the pretrial and evidence skills of attorneysassigned to criminal cases in and out of the courtroom.Seminar reinforced basic principals in constitutionalissues, admissibility, cross-examination/impeachment,relevance, character evidence, hearsay, and lay andexpert opinions. Part 8 of this series discussed privilegesrecognized in federal proceedings and the elements ofeach such privilege. Presentation included informationon how government attorneys should respond when adefendant or witness asserts an evidentiary privilege.Virginia Association of Personal Care Providers Ninth AnnualConference. Topics included elements of health carefraud, examples of fraudulent activities normally foundin a personal care provider fraud case.Virginia State Bar Association’s Health Law Update. Provideda legislative update during which members of theVirginia government present information and respondto questions from attendees. Sponsored by Virginia BarAssociation’s Health Law Section.Worth a Thousand Words – Demonstrative Evidence andElectronic Presentation of Exhibits at Trial. Presentation onhow to use PowerPoint, paper boards, and other typesof exhibits at trial.38

DATES AND PERSONNEL ATTENDING TRAININGDate Program Personnel7/9-10/09 American Bar Association’s Annual Litigation Institute forTrial TrainingOne Assistant Attorney General7/9-10/09 SAS Programming Introduction: Basic Concepts Course One Assistant Attorney General7/14/09 Excel Training One Investigator7/14-17/09 National Advocacy Center Conference: Legal InformationTechnology for Attorneys Seminar7/28-31/09 National Association of Medicaid Fraud Control Unit’sIntroduction to Medicaid Fraud – 102 Training ProgramOne Assistant Attorney GeneralOne Assistant Attorney GeneralFive InvestigatorsOne Auditor7/31/09 Health Care Fraud One InvestigatorOne Forensic Auditor8/3-7/09 National Advocacy Center Conference: IntermediateCriminal Trial Skills8/13-14/09 Lexis-Nexis Concordance One ParalegalOne Assistant Attorney General8/14/09 Civil Discovery Institute Four Assistant AttorneysGeneral8/17-20/09 Office of Inspector General, U.S. Department of Health andHuman Service’s Administrative Training ConferenceDirectorOne Program Coordinator9/9-11/09 John Reid School of Interviewing and Interrogation One Nurse Investigator9/10/09 Department of Medical Assistance Services Pharmacy andPreferred Drug List Program9/13-17/09 National Association of Medicaid Fraud Control Unit’sAnnual ConferenceThree InvestigatorsOne Assistant Attorney GeneralDirectorOne Deputy DirectorOne Chief Counsel and SectionChief9/15/09 Department of Social Services APS Workers Team Meeting One Investigator9/17/09 The Power of PowerPoint for Paralegals: Creating an EffectiveTrial PreparationOne Paralegal9/22/09 Legal Research for Non-Lawyers; Case Law One Paralegal9/28-10/2/097/10/098/7/099/11/0910/2/0911/6/0912/4/092/5/103/5/104/2/106/4/106/25/10National Health Care Anti-Fraud Association’s FundamentalsAcademy for Health Care Fraud Investigators Part 1 and 2Department of Medical Assistance SAS Users GroupThree Senior InvestigatorsOne InvestigatorsOne Investigator39

DATES AND PERSONNEL ATTENDING TRAININGDate Program Personnel9/29/09 How to Introduce Typical Trial Exhibits and Use ThemEffectivelyOne Assistant Attorney General10/6/09 John E. Reid: Lawyers’ Institute of Forensic Interviewing Five Assistant AttorneysGeneral10/12-14/09 Taxpayers Against Fraud Conference One Assistant Attorney General10/13/09 Before You Take the Plunge – What you Need to Know aboutPatent, Copyright and Trademark CostsOne Assistant Attorney General10/16/09 A Day in Discovery – Win Your Case Before Trial (Virginia CLE) Four Assistant AttorneysGeneral10/20/09 National Association of Medicaid Fraud Control Unit’s GlobalCase Committee Meeting10/26/09 National Advocacy Center Conference: Federal PracticeSeminarOne Assistant Attorney GeneralOne Assistant Attorney General10/26-30/09 National Adult Protective Services Association Conference Chief of Elder Abuse andNeglect SquadOne Nurse InvestigatorTwo Investigators10/27-29/09 John E. Reid: Interview and Interrogation Techniques Two Investigators10/27-30/09 NAMFCU Introduction to Medicaid Fraud Training Program One Assistant Attorney GeneralOne Investigator Supervisor11/10/09 Pressure Ulcer Management: Clinical and LegalCompetence CourseTwo Nurse Investigators11/13/09 Adobe Tricks and Tips One Paralegal11/16-20/09 National Health Care Anti-Fraud Association 2009 AnnualTraining Conference11/19/09 Virginia Association of Personal Care Providers Ninth AnnualConference12/1-4/09 California District Attorneys Association’s Elder AbuseSymposiumThree InvestigatorsAdministrative, Training andOutreach ManagerOne InvestigatorOne Program CoordinatorOne Nurse InvestigatorOne Investigator12/17/09 Investigation and Discovery One Paralegal1/11-14/10 Medicaid Fraud Control Unit’s In-House Training Two CoordinatorsDirectorTwo ParalegalsOne ManagerTen Assistant Attorneys GeneralSeventeen InvestigatorsFour AuditorsTwo Criminal AnalystsTwo Nurse InvestigatorsOne Forensic Supervisor40

DATES AND PERSONNEL ATTENDING TRAININGDate Program Personnel2/23/10 National Health Care Anti-Fraud Association TrainingWebinar2/23-25/10 National Association of Medicaid Fraud Control Unit’sIntroduction to Medicaid – 101 Training ProgramOne InvestigatorOne Senior InvestigatorTwo Managers2/24-26/10 American Bar Association’s Institute on White Collar Crime One Assistant Attorney General2/28/10 Managing a Large Document Review for Paralegals(Webcast training)One Paralegal3/2-5/10 NAMFCU Medicaid Fraud 102 Training Program Two Criminal InvestigatorsTwo Senior CriminalInvestigatorOne Assistant Attorney General3/2/10 Case Generation: Medicare Fraud Strike Force and Projectsto Deter Health Care FraudOne Assistant Attorney GeneralOne Deputy Director andAssistant Attorney General3/10/10 United States Attorney’s Office’s Client Privilege Training One Assistant Attorney General3/11/10 American Bar Association’s Anti-Kickback Law BasicsTeleconference3/11/10 United States Department of Justice’s Office of LegalEducation Evidence for Criminal Litigators, Part 8.3/17/10 Professional Responsibility CLE on JTN: A Prosecutor’sDisclosure Obligations.3/22/10 NAMFCU Global Case Committee Meeting.3/23/10 Worth a Thousand Words – Demonstrative Evidence andElectronic Presentation of Exhibits at Trial.Four Assistant AttorneysGeneralOne Assistant Attorney GeneralOne Assistant Attorney GeneralOne Chief and AssistantAttorney GeneralOne Assistant Attorney General3/24/10 Virginia SAS Users Group One Investigator3/24-25/10 National Association of Medicaid Fraud Control Units’Directors Symposium4/1/10 How Well Do Law Firms Handle Digital Information asEvidence” WebinarDirectorOne Criminal Investigator4/12-14/10 ABA Health Care Fraud Conference One Assistant Attorney GeneralOne Civil Investigator4/21/10 Crime Victims’ Right Act Presentation Two Assistant AttorneysGeneral4/27/10 Master Lexis.com One Paralegal5/4-6/10 NAMFCU Investigating and Settling Global Cases Training One Assistant Attorney General5/11-15/10 National Institute on Health Care Fraud 20th AnnualConferenceTwo Assistant AttorneysGeneralOne Civil Investigator5/11/10 Alternative Dispute Resolution One Assistant Attorney General5/11/10 Criminal E-Discovery One Assistant Attorney General41

DATES AND PERSONNEL ATTENDING TRAININGDate Program Personnel5/12/10 Virginia Health Law Update One Assistant Attorney General5/27/10 John E. Reid: Interview and Interrogation One DayAdvanced Course6/3/10 Department of Medical Assistance Services Cost ReportTrainingTwo Investigators6/3/10 Health Care Fraud and Abuse: What You Need to Know One Paralegal6/7-10/10 National Association of Medicaid Fraud Control Unit’s GlobalCase MeetingOne Assistant Attorney GeneralOne Assistant Attorney General6/22/10 Investigation and Management Seminar One Investigative Supervisor6/28-29/10 Clearwell/Document Management Training One Computer ProgrammerOne Evidence/Manager Analyst6/1-29/10 Cyber Security Awareness Training All MFCU StaffDesign by the Office of Graphic CommunicationsVA Department of General Serviceswww.vaag.comOffice of the Attorney GeneralMedicaid Fraud Control Unit900 East Main StreetRichmond, Virginia 23219VIRGINIA OFFICE OF THE ATTORNEY GENERALMEDICAID FRAUD CONTROL UNITRECOGNIZE THE PROBLEMFraudulent ProvidersAlthough the vast majority of health care providers arehonest and dedicated to providing high quality healthcare to their patients, Medicaid provider fraud costsAmerican taxpayers hundreds of millions of dollarsannually and threatens the integrity of the Medicaidprogram. The Virginia Medicaid Fraud Control Unitprotects the Commonwealth by investigating andprosecuting Medicaid fraud from providers receivingpayment from the Commonwealth’s MedicalAssistance Program (Medicaid). The Unit also investigatesallegations of abuse or neglect of elderly andincapacitated adults receiving benefits through theMedicaid program.You can help by recognizing provider fraud, such as:• Phantom Billing: billing for services not rendered.• Fraudulent Billing: billing for unnecessary servicesor tests.• Embezzlement: stealing money entrusted to theproviders by patients, such as their nursing homeresident accounts.• Upcoding: billing for more expensive services thanwhat was provided.• Kickbacks: one provider pays another in exchangefor referrals or other business.• Duplicate Billing: billing for the same servicesmore than once; or billing more than one paymentsource (i.e., Medicaid and a private insurer).SAVE YOUR MEDICAID FUNDSREPORT MEDICAID FRAUDAbuse or NegPatients by HThe Medicaidand prosecutenursing homeMedicaid Fraud Control UnitVirginia Office of the Attorney GeneralYou can helpneglect, such• Unexplain• Fractures• Pressure u• Malnutritio• Dehydratio42Medicaid Fraud Control Unit Brochure

Agency Street Address:Virginia Attorney General’s Office900 East Main StreetRichmond, Virginia 23219(804) 786-2072 (Main Number)Format:The Virginia Attorney General’s Office has publishedits 2010-2011 Annual Report in a summary format thatincludes a letter from the Director, general informationabout the MedicaidFraud Control Unit, trainingupdates, a summary of criminal and civil cases, andother pertinent information.To Report Medicaid Fraud:If you would like to report a suspected case ofMedicaid fraud or have questions, please contact us at 1-800-371-0824 or (804) 786-2071.The Unit is housed in the Pocahontas Building across from Capitol Square.The Unit can be contacted at by mail at:900 East Main StreetRichmond, Virginia 23219or by email: MFCU_mail@oag.state.va.usOAG Web Site:www.vaag.comAdditional InformationCopies of the Virginia Attorney General’s Office’sMedicaid Fraud Unit’s Annual Report are availablewithout charge. This report can be viewed by visiting www.vaag.com, or requests for this item can be made by writing to:Esther Welch Anderson, ManagerAdministrative, Training and OutreachMedicaid Fraud and Control UnitVirginia Attorney General’s Office900 East Main StreetRichmond, VA 23219ewelch@oag.state.va.us(804) 692-05191-800-371-0824 toll free(804) 371-0779 localCreditsDesign:Virginia Office of Graphic CommunicationsDepartment of General Services1100 Bank Street, Suite 420Richmond, VA 23219Capitol Area and Staff Photography:Esther Welch Anderson and Debbie MahoneReport compiled by Esther Welch Anderson,MFCU Administrative, Training and Outreach Manager,the Medicaid Fraud Control Unit of the Office of the Attorney General, Richmond, Virginia43

Medicaid Fraud Control UnitOffice of the Attorney General900 East Main Street, Richmond, VA 23219To report suspected Medicaid fraud, contact MFCU at:1-800-371-0824 or (804) 786-2071(804) 786-3509 (fax)44MFCU_mail@oag.state.va.usor the Department of Medical Assistance Services at:RecipientFraud@DMAS.virginia.gov