Texas Medicaid fraud whistleblowers get $4.2M

A U.S. District Court judge in Texas has awarded $4.2 million in damages to the state and three former employees of an orthodontist convicted of Medicaid fraud as part of a whistleblower lawsuit.

If state and federal authorities collect $4 million from the clinic, the former employees could theoretically split $630,000 to $840,000, according to a story in the Amarillo Globe-News.

In April, U.S. District Judge Mary Lou Robinson sentenced David Goodwin, DDS, owner of Goodwin Orthodontics, to more than four years in prison and three years of supervised release and ordered him to pay $1.8 million in restitution for defrauding the Texas Medicaid program of more than $1 million.

Dr. Goodwin was indicted last year on 11 counts of healthcare fraud. The indictment alleged that from January 2008 through March 2011, Dr. Goodwin devised a scheme to defraud the Texas Medicaid program by billing more than $2.6 million for services he claimed he provided, when in fact some of the services were not medically necessary or dental assistants provided those services when no dentist or orthodontist was present to supervise. As a result of this scheme, Medicaid paid more than $1.5 million for claims filed by Dr. Goodwin.

As part of his scheme, according to the indictment, Dr. Goodwin practiced orthodontic dentistry two weeks each month in Amarillo and two weeks each month at an office in Indiana. To maximize the number of Medicaid patients seen, employees regularly scheduled more than 100 patients per day and intentionally scheduled large numbers of Medicaid patients for days when Dr. Goodwin was out of town.

Lawmakers alleged that Dr. Goodwin directed dental assistants to perform impermissible acts to accommodate the large volume of patients, such as comprehensive examinations, diagnoses, and treatment planning for Medicaid patients when he knew that only licensed dentists were permitted to perform those acts.

Last year, authorities seized $244,235.67 from five JPMorgan Chase commercial and personal bank accounts associated with Dr. Goodwin, his wife, and his business. In 2011, they seized $108,083 from the business.