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Medicaid Fraud Control Unit Achieves Major Recoveries and Successful Prosecutions in South Dakota

The Medicaid Fraud Control Unit (MFCU) in South Dakota reports significant recoveries and successful cases. In FY2012, the unit recovered $2,531,736 with a return on investment of $6.52 per dollar spent. In FY2013, recoveries soared to $7,388,048, yielding an impressive $18.63 ROI. Notable case: Cary Feldman, a Rapid City optometrist, faced felony charges leading to over $363,000 in restitution and penalties. This case highlights MFCU's collaboration with multiple agencies to combat Medicaid fraud, protecting taxpayer interests effectively.

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Medicaid Fraud Control Unit Achieves Major Recoveries and Successful Prosecutions in South Dakota

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  1. OFFICE OF ATTORNEY GENERAL MEDICAID FRAUD CONTROL UNIT (MFCU)

  2. MFCUFY2012 Total Recoveries: $2,531,736 Total Budget: $388,183 • 25% State Share $97,046 • 75% Federal Share $291,137 Return on Investment: $6.52 per $1 spent

  3. MFCUFY2012 Cases Opened: 44 Closed: 50 Pending: 30

  4. MFCUFY2013 (through Dec. 14, 2012) Total Recoveries: $7,388,048 Total Budget: $396,605 • 25% State Share $99,151 • 75% Federal Share $297,454 Return on Investment: $18.63 per $1 spent

  5. MFCUFY2013 Cases (through Dec. 14, 2012) Opened: 9 Closed: 17 Pending: 22

  6. MFCU • Majority of Recoveries come from out of state Pharmaceutical companies. Vast majority of Providers in South Dakota are honest and ethical. These recoveries benefit South Dakota taxpayers.

  7. MFCUNotable Case Cary Feldman – former optometrist in Rapid City • Largest criminal health care provider fraud case ever prosecuted in South Dakota, in either State or Federal Court. $362,457.90 Medicaid Restitution +__ $592.00 Medicare Restitution $363,049.90 Total Restitution $363,049.90 - $80,000.00 Check - $157,000.00 Coin Collection $126,049.90 Remaining Restitution to be paid

  8. MFCUNotable Case cont. Feldman was convicted of: • Grand Theft by Deception (Class 4 Felony) • Making False Medicaid Claims (Class 5 Felony) Sentence: • Grand Theft by Deception • 10 years (the maximum) • Making False Medicaid Claims • 5 years (the maximum) • Suspended Execution • 15 years probation • Pay all restitution • Serve 6 months in county jail • Optometry Board revoked his license • Will be placed on OIG Exclusion List

  9. MFCUNotable Case cont. Feldman case was investigated and prosecuted by MFCU, with assistance from: • South Dakota Department of Social Services • Federal Department of Health and Human Services Office of Inspector General • South Dakota Division of Criminal Investigation • Spearfish Police Department • Rapid City Police Department • Pennington County Sheriff’s Office • Pennington County Office of State’s Attorney • Minnehaha County Sheriff’s Office • South Dakota Office of United States Attorney • South Dakota Board of Examiners in Optometry • South Dakota Property Management (sale of coin collection) Feldman case is a good example of State, Federal, and Local teamwork – we leverage government resources to achieve results in a cost-effective manner.

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