- Associated Press - Friday, March 10, 2017

PHOENIX (AP) - The conviction of the operator of a New Mexico medical transportation company marks the latest incident of health care fraud involving false billings by transport companies to Arizona’s Medicaid program.

Farmington resident Cory Werito pleaded guilty Thursday in a federal court in Albuquerque in a case involving fraudulent billings to the Arizona Health Care Cost Containment System through his medical transportation company.

A statement from the U.S. attorney’s office in New Mexico said Werito and his co-defendant, Rosita Toledo, created and ran CW Transport, which provided non-emergency medical transport to Arizona Medicaid recipients. Together they were charged with nine counts of health care fraud, and Werito faced an additional charge of aggravated currency structuring. They were accused of submitting more than 18,000 claims for reimbursement between 2011 and 2013, most of them completely or substantially false, and defrauding the state’s Medicaid program of nearly $2 million.

Werito signed a plea agreement Thursday that carries a maximum 10 year sentence and requires him to repay more than $1.2 million.

Toledo has pleaded not guilty and awaits trial. Her federal public defender did not immediately return a call seeking comment on Friday.

The case is the third involving medical transport companies defrauding Arizona’s Medicaid program that have cost the program millions of dollars.

In December a federal court jury convicted Arizona Medical Transportation LLC owner and operator Elseddig Elmarioud Musa of 39 counts of health care fraud and aggravated identity theft for false billings to Arizona’s Medicaid program. A 2015 indictment said Musa fraudulently billed AHCCCS over $1.2 million for thousands of transports that never occurred.

It followed the November sentencings of a northeastern Arizona couple in a separate case. Both were sentenced to prison terms and ordered to pay millions of dollars of restitution after pleading guilty to health care fraud involving false claims surrounding medical transports.

The U.S. attorney’s office for Arizona said Sylvia Jean Begay and Virgil C. Begay each owned a company that made thousands of fraudulent claims to Arizona’s Medicaid program.

Heidi Capriotti, a public information officer at the state’s Medicaid program, said AHCCCS spent about $200 million on all forms of non-emergency medical transports in 2016. She said the state’s Medicaid program identified medical transportation providers as having higher potential risk of fraud several years ago and “subjects them to additional levels of scrutiny above and beyond (its) existing standard patterns.”

“We dedicated resources specifically to focus on non-emergency transportation providers and we conduct regular audits and analysis of billing patterns,” Capriotti said.

In May, the program’s former chief procurement officer was sentenced to 10 years in prison and ordered to forfeit his state retirement benefits and pay full restitution after earlier pleading guilty in a yearslong fraud scheme involving $5.9 million in fake billings for supplies.



Click to Read More

Click to Hide