A civil Medicaid fraud complaint has been filed against two former physicians and their business entities. The complaint was filed against 81-year-old Don J. Wagoner of Burlington, Indiana and 80-year-old Marilyn L. Wagoner of Burlington, Indiana, as well as their business entities, Wagoner Medical Center P.C., Don J. Wagoner M.D., Marilyn L. Wagon M.D. P.C., and Wagoner Medical Center LLC for filing false claims.
Documents in the case explain that from 2011 to 2013, Don J. Wagoner and his wife, Marilyn L. Wagon, practiced medicine together at the Wagoner Medical Center. The couple usually required patients seeking a prescription for opioid pills or other pain medication to first submit a urine sample to test for the presence or absence of nine or more drugs or drug classes. Multiplexed screen kits cost the defendants no more than roughly five dollars and each urine sample would be tested on the same day using the simple kit.
The defendants are accused of billing Indiana Medicaid and receiving $171.27 per patient, despite the fact that Indiana Medicaid billing rules only allowed them to bill $20.83 per patient. The defendant allegedly tried to cover up the fraud by claiming to collect and analyze nine or more urine samples for each patient. In reality, they had only collected and analyzed a single urine sample. The defendants are accused of carrying out the scheme for more than 6,400 claims and receiving a total overpayment from Indiana Medicaid of more than $1.1 million.
In 2013, Don J. Wagoner and Marilyn L. Wagoner permanently surrendered their licenses to prescribe drugs and to practice medicine in relation to a state criminal investigation. The investigation ultimately led to felony drug dealing convictions of Mr. Wagoner. At this point in time, the defendants remain innocent until proven guilty beyond a reasonable doubt in a court of law. Additional details regarding the case can be found here.