Spokane medical provider allegedly stole more than $ 5 million in Medicaid funds

The owner of a Spokane-based health clinic faces charges of theft and money laundering after investigators alleged fraudulent Medicaid billing totaling more than $ 5 million since 2017.

Paul Means and his firm Ablia Healthcare were targeted following an audit of his billing which revealed irregularities, according to court records. Investigators believe that the proceeds of the program, which involved billing the state for intensive in-person exams when performed over the Internet or not at all, was used to purchase a $ 300,000 house on the South Hill of Spokane and several vehicles.

Means, who has practiced in the state since 2009 and has no evidence of discipline from the Washington Department of Health, declined to comment on the allegations when contacted by phone on Wednesday. He returned the comment to his lawyer, but did not name one before ending the phone call. No lawyer was listed in court records Wednesday.

Investigators with the Medicaid Fraud Control Division of the Washington Attorney General’s Office have been following Means since at least March, court records show. They were warned by an unusually large amount of billing codes indicating in-person consultations lasting half an hour or more, many of them at an in-person drug treatment center in Spokane Valley.

Payment requests are submitted under a specific billing code, and the health authority is responsible for verifying that the documentation matches the payment request. An independent audit of Abilia’s records found that 97% of the more than 6,000 payment claims submitted by the company were unsubstantiated, according to court records, and there was evidence that the company was simply copying and pasting justifications written payment in multiple files. .

Patients surveyed indicated that their visits were frequently made on tablet computers and often lasted 10 minutes or less. Surveillance showed that during some of these alleged consultations, Means was crossing the state or shopping, officials said.

At least three of Abilia’s employees who made patient visits that were then billed as in-person visits live outside the Spokane area. One lives in South Carolina, according to court records.

Means started the company in 2013, but the irregular billing only became apparent in mid-2017, according to an investigation report prepared by Scott Tolackson, senior investigator in the Fraud Control Division. That report was unsealed in court records last week, the same day a summons was issued to Means and four of his employees.

Means’ purchases this year included a 2020 Lexus luxury SUV and a 2019 Airstream trailer. The latter has been purchased, Means wrote in a letter requesting an exemption to allow the sale during COVID-19 restrictions, to allow him to travel. weekly across the state to visit patients in Western Washington.

A tracker placed on the trailer said it had only traveled once from Means’ home on South Helena Street, and was then parked overnight at a campground near Bellingham in August , and not near a treatment center.

Abilia also requested and received $ 110,000 in coronavirus assistance from the federal government, according to court records. Washington University also paid the company just over $ 176,000 “for its participation in a drug-first study for opioid disorders,” according to court records.

Investigators who signed the search warrant seized several vehicles, two homes in South Hill and a property in Cheney, all of which were allegedly purchased with fraudulent funds.

The warrant says investigators will press charges of first-degree theft, a felony punishable by up to 10 years in prison; making a false Medicaid statement, a felony punishable by up to five years in prison; and money laundering, another crime punishable by up to five years in prison.

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