Friday, December 14, 2012

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Amarillo Doctor Pleads Guilty to Health Care Fraud in Case Investigated by State and Federal Officials

The following news release was issued by the U.S. Attorney for the Northern District of Texas on Dec. 13, 2012:

Dr. Michael David Goodwin Billed the Texas Medicaid Program at Least $2.6 Million for Services He Claimed He Provided

AMARILLO — Dr. Michael David Goodwin, 63, an orthodontist who practices in Amarillo, Texas, and Crown Point, Indiana, pleaded guilty in federal court today, before U.S. District Judge Mary Lou Robinson, to one count of health care fraud related to his scheme to defraud the Texas Medicaid program, announced U.S. Attorney Sarah R. Saldańa of the Northern District of Texas. Goodwin faces a maximum penalty of 10 years in federal prison, a $250,000 fine and restitution. He will remain on bond pending sentencing, which is set for February 7, 2013.

Also, today, the government filed motions with the Court to dismiss, without prejudice, the indictment pending against Goodwin’s co-defendants Patricia Yolanda Goodwin, his wife, and Annette Hastings. Patricia Goodwin made, or was involved in, all business decisions for Goodwin Orthodontics, and Hastings was the office manager.

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.

Goodwin’s fraudulent conduct resulted in significant payments to him by the Texas Medicaid Program. The gross proceeds resulting from the scheme are at least $1 million.

The indictment also includes a forfeiture allegation which would require Goodwin, upon conviction, to forfeit the total amount of the gross proceeds traceable to the offenses, as well as the more than $244,000 the government seized in May and July 2011 from Goodwin’s JP Morgan Chase accounts.

The case is being investigated by the Medicaid Fraud Control Unit of Office of the Attorney General and the FBI. Special Assistant U.S. Attorney Sally Helmer and Assistant U.S. Attorneys Matt Gulde and Josh Burgess are in charge of the prosecution; Assistant U.S. Attorney Steve Jumes is handling the forfeiture.