Tuesday, February 28, 2012

Feds link orthodontist to Medicaid fraud scheme

By BOBBY CERVANTES amarillo.com Copyright 2012 Amarillo Globe-News. All rights reserved.

February 29, 2012 - 12:18am

Feds link orthodontist to Medicaid fraud scheme


Patients and former employees likened the Amarillo Medicaid fraud scheme to “herding cattle.”

Amarillo orthodontist Dr. Michael Goodwin scheduled up to 400 Medicaid patients a day and frequently billed the government for work he never performed, according to court records.

In late May and early July, authorities seized $244,235.67 from five JP Morgan Chase commercial and personal bank accounts associated with Goodwin, his wife and his business.

Goodwin billed the government a total of $1.67 million in fraudulent claims from April 2008 to April 2011, according to a federal forfeiture complaint the government filed Monday seeking to keep the seized money.

Goodwin, who also has an office in Indiana, has not been charged with a crime. His Amarillo office at 3629 Wolfin Ave. was closed Tuesday and messages were not immediately returned.

Goodwin and his wife, Patricia, did not file a claim to the seized money, according to the complaint.

Indiana lawyer Clark Holesinger, identified in the complaint as representing Goodwin in “a related investigation,” declined to comment Tuesday.

The complaint said Goodwin billed Medicaid for about $11.7 million from March 2008 to March 2011, triggering payouts totaling about $7.5 million, an FBI agent’s affidavit said. About 95 percent of Goodwin Orthodontics’ patients, who were usually seen on a monthly basis, were Medicaid recipients, the affidavit said.

The Texas Health and Human Services Commission, which administers Medicaid in Texas, filed a request to be reimbursed for the fraudulent claims it paid.

On Feb. 13, 2008, Goodwin became an individual Medicaid provider, which allowed him to bill the government program only for “services personally provided by Goodwin,” the affidavit said. But in 2009, the Medicaid Fraud Control Unit in the Texas Attorney General’s Office received information that Goodwin billed the government for work done by dental assistants — who worked on patients “at Goodwin’s direction and without his direct supervision while Goodwin was out of town, away from the office or even while present in the office,” the affidavit said.

FBI investigators learned from interviews with employees that Goodwin did not supervise his dental assistants when they performed work on patients state law prohibited them from doing, the document said. He also scheduled patients in 10-minute increments, “causing pressure for assistants to practice dentistry quickly” and eventually billed Medicaid for their work, the affidavit said.

“Dental assistants were discouraged from asking Goodwin for help and encouraged to request assistance from other assistants instead,” the document said. “All the patients reported that they rarely saw Goodwin and that assistants did nearly all the work, to include putting braces on, making adjustments, fixing broken brackets and removing braces.”

The FBI affidavit also said Goodwin flew from Texas to Indiana almost every month, billing Medicaid for patient services in Amarillo on dates when flight records showed he was in Indiana.

“A comparison of the airline records and the claims data corroborated the initial allegation of service being provided while Goodwin was out of town,” the affidavit said. “He misrepresented to Medicaid that he himself provided the services or was there to supervise them.”

To obtain approval for the program, Medicaid providers must submit a score sheet verifying patients’ medical needs for orthodontic work, the affidavit said. FBI investigators said Goodwin or employees at his direction falsified those sheets “so that virtually every Medicaid patient would be approved for braces, even when treatment was not necessary.”

Goodwin “routinely” billed for services he did not provide, the affidavit said.

In their investigation, state and federal authorities reviewed Goodwin’s travel records, his office’s Medicaid claims, patient files and several bank records. They also interviewed patients and former and current employees about Goodwin’s practices, the document said.

Goodwin’s Texas dentist license expires Oct. 31, according to the State Board of Dental Examiners. The board’s website listed no disciplinary actions against Goodwin’s license. He also holds two active dentist licenses in Indiana, according to the State Board of Dentistry’s site.