Federal Prison for Orthodontist with Crown Point Office
The United States Attorney for Texas’ Northern District says an orthodontist with practices in Crown Point, Indiana and Amarillo, Texas has a 50-month federal prison term and mroe than $1.8-million in restitution to pay in a Texas Medicaid health care fraud case. U.S. Attorney Sarah R. Saldaña of the Northern District of Texas issued the following news release April 9, 2013.
CROWN POINT ORTHODONTIST SENTENCED TO 50 MONTHS IN FEDERAL PRISON ON HEALTH CARE FRAUD CONVICTION
Dr. Michael David Goodwin Billed the Texas Medicaid Program at Least $2.6 Million for Services He Claimed He Provided
AMARILLO, Texas — Dr. Michael David Goodwin, 63, an orthodontist who practiced in Amarillo, Texas, and Crown Point, Indiana, was sentenced today by U.S. District Judge Mary Lou Robinson to 50 months in federal prison and ordered to pay $1,810,960 in restitution, following his guilty plea in December 2012 to one count of health care fraud related to the Texas Medicaid program. In addition, Goodwin must forfeit $1,558,911, which are the gross proceeds traceable to his offense, as well as more than $244,000 the government seized in May and July 2011 from his JP Morgan Chase accounts. Judge Robinson ordered that he surrender to the Bureau of Prisons on April 29, 2013. Today’s (4/9/13) announcement was made by U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
According to documents filed in the case, from January 2008 through March 2011, Goodwin devised a scheme to defraud the Texas Medicaid program by billing the program at least $2,626,125 for services he claimed he provided, when in fact, as he well knew, some of the services were not medically necessary, or dental assistants provided those services when no dentist or orthodontist was present to supervise, and even when present, did not directly supervise or provide any services.
Goodwin practiced orthodontic dentistry approximately two weeks each month at Goodwin Orthodontics in Amarillo and approximately two weeks each month at his Indiana office. In order to maximize the number of Medicaid patients seen, on numerous occasions, Goodwin had his employees schedule more than 100 patients per day and intentionally schedule large numbers of Medicaid patients for days when Goodwin was scheduled to be out of town. To accommodate the large volume of patients, Goodwin directed dental assistants to perform impermissible acts, including comprehensive examinations, diagnoses and treatment planning for Medicaid patients when he knew that only licensed dentists were permitted to perform those acts.
Goodwin devised a generic treatment guideline for dental assistants to follow in treating Medicaid beneficiaries that included dental assistants making treatment decisions at most appointments, without Goodwin examining the patients; confirming or revising the diagnoses; or confirming or revising the treatment plans. Goodwin also caused his billing staff to falsely and fraudulent state on Medicaid claims that he was the performing provider for all services that had been impermissibly delegated to and performed by dental assistants.
In April 2009, Goodwin hired substitute general dentists to create the appearance of direct supervision of dental assistants when he was away from the office. These substitute dentists were not enrolled Medicaid orthodontic providers. These substitutes did not provide services to Medicaid beneficiaries, did not directly supervise the dental assistants who provided the services, and were not always present in the office for orthodontic procedures. Again, Goodwin caused his billing staff to falsely and fraudulently state on Medicaid claims that he was the performing provider for all services performed when he was out of town and dental assistants provided those services when a substitute dentist was present to supervise, but did not directly supervise or provide any services.
Goodwin also instructed his dental assistants to falsely and fraudulently indicate in the patient records that an “adjustment” was performed on every visit, except for the initial consult, when no such adjustment had been provided and when he knew this violated Medicaid Rules.
The case was investigated by the Medicaid Fraud Control Unit of Office of the Texas Attorney General and the FBI. Assistant U.S. Attorney Christy Drake and Special Assistant U.S. Attorney Sally Helmer were in charge of the prosecution, and Assistant U.S. Attorney Diane Kozub handled the forfeiture.