news release
INDIANAPOLIS — The U.S. Department of Justice has reached a settlement of $1.7 million with a former Indiana physician, addressing allegations that he submitted thousands of fraudulent claims to the state’s Medicaid program, as federal officials reported.
The settlement involves Don Wagoner from Burlington, who previously ran Wagoner Medical Center LLC. The U.S. Attorney’s Office for the Northern District of Indiana stated that Wagoner submitted over 5,000 false Medicaid claims, which led to approximately $1 million in improper payments. These fraudulent claims primarily revolved around urine drug tests for patients seeking prescriptions for opioids and other painkillers, as indicated in court records. Patients consented to provide urine samples for drug screening, which Wagoner tested using a single multiplex screening kit.
Wagoner billed Indiana Medicaid for testing that supposedly screened patients for the same substances more than nine times, despite conducting only a single test for each patient.
This resulted in reimbursements of about $171 per patient, significantly higher than the Medicaid allowable rate of $20.83 per test. Prosecutors stated that the scheme was hidden by inaccurately claiming that multiple samples were gathered and analyzed independently, when in reality, only one sample underwent testing.
In December 2017, both the United States and the state of Indiana initiated a civil lawsuit under the False Claims Act, seeking repayment and additional fines. Several years ago, Wagoner gave up his medical and prescription licenses. He was subsequently convicted of felony drug trafficking. His wife faced charges in the initial case but was later deemed unfit for trial due to cognitive decline. In total, more than 95 charges were brought against Wagoner and his associates.
Federal prosecutors indicated that this settlement guarantees that Wagoner will not retain any profits from the fraudulent Medicaid claims and reinforces the commitment to recover funds wrongly disbursed from public health resources.
