MM Curator summary
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[MM Curator Summary]: Decent-sized DME fraud, mostly for orthopedic equipment made possible by kickbacks to marketers.
Wakeen Griffin, co-owner of New Horizons Durable Medical Equipment based in Frisco, TX, was sentenced to 49 months of federal incarceration to be followed by a year of supervised release for his role in a medical equipment fraud scheme. In addition, Griffin was ordered to pay $5,114,016.19 in restitution to government health care programs. A jury convicted Griffin of conspiracy to defraud the United States and to pay and receive healthcare kickbacks, as well as seven counts of payment and receipt of kickbacks.
Griffin obtained patients by offering and paying kickbacks to marketers as well as disguising illegal payments as marketing services and outsourced business services. Griffin then submitted false claims to both Medicaid and Medicare for orthopedic equipment that was never provided, not medically necessary, and not authorized by a physician.
The investigation was conducted by Sergeant Doug Wood, Investigative Auditor Jennifer Blakely, and Captain Justin Boyce of the Texas Medicaid Fraud Control Unit (“MFCU”) in partnership with the Federal Bureau of Investigation and the U.S. Department of Health and Human Services’ Office of Inspector General. The case was prosecuted by the Department of Justice Health Care Fraud Strike Force.
The OAG’s Medicaid Fraud Control Unit is dedicated to ensuring that those who exploit our healthcare system for personal gain are brought to justice by aggressively pursuing those who engage in healthcare fraud, working to safeguard taxpayer funds, and defending the integrity of vital healthcare programs. In the last fiscal year alone, the MFCU recovered more than $236 million in settlements and judgments for Texas taxpayers. In Texas, Medicaid costs taxpayers over $40 billion per year. Federal and industry authorities estimate that fraud comprises up to ten percent of the costs of the Medicaid program, making Medicaid fraud a $4 billion problem in Texas.
The MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $20,944,200 for fiscal year 2023. The remaining 25 percent, totaling $6,981,395, is funded by the State of Texas. For every dollar of state funding, the OAG’s MFCU recovers more than 33 dollars for taxpayers. If you suspect Medicaid fraud or abuse, or patient neglect, please report it by visiting the OAG’s website.