Doctor in New York pleads guilty to $500K Medicaid fraud scheme
October 06, 2016, Rochester, NY —
Attorney General Eric T. Schneiderman today announced the resolution of criminal charges and civil liability arising from billing practices at Clifford Hurley, D.O. LLC, a medical practice in the Town of Gates. Clifford Hurley, a doctor of osteopathy, pled guilty on August 17 to misdemeanor falsification of business records for recording office visits that he did not provide, and Hurley’s business corporation pleaded guilty on August 31 to felony grand larceny in the third degree arising from services that were improperly billed during the time period of July 9, 2013 to May 6, 2014.
“Health care providers who defraud Medicaid hurt taxpayers and the vulnerable New Yorkers who rely on the critical services the Medicaid program provides,” Attorney General Schneiderman said. “We will fight to hold fraudulent medical professionals accountable and recover those ill-gotten gains.”
Along with the criminal pleas, the Attorney General entered a civil settlement agreement requiring Hurley to pay over $500,000, which resolved claims for overbilling services and/or procedures relating to clinical testing services, billing for counseling services provided by ineligible staff, and improper billing of prescription pick-ups and medication refills.
“Victims in crimes like this are honest, hard-working New Yorkers who are unnecessarily forced to pay more for health insurance and more in taxes to support Medicaid,” said Maria T. Vullo, Superintendent of Financial Services. “The Department of Financial Services is committed to aggressively fighting and stamping out health care fraud and we are pleased to work with the Office of the Attorney General in resolving this case.”
The Rochester Regional Office of the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) began investigating this case after receiving a referral from Excellus, LLC, a Medicaid Managed Care Organization that services Medicaid recipients in Monroe County. Managed Care Organizations are required to report suspected fraud.
The Attorney General thanks William Fedrau of the New York State Department of Financial Services for his assistance during the investigation.
The investigation was conducted by MFCU Investigator Jason Rice and Principal Auditor-Investigator Grace Quinn with assistance from MFCU Deputy Chief Investigator William Falk. The case was prosecuted by Assistant Attorneys General Margaret Jones and Jennifer Sommers. The Rochester MFCU office is led by Regional Director and Chief of Criminal Investigation-Upstate, Catherine Wagner. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul Mahoney.
Source: New York Attorney General