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OFFICE OF ATTORNEY GENERAL

OFFICE OF ATTORNEY GENERAL. MEDICAID FRAUD CONTROL UNIT (MFCU). MFCU FY2012. 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. MFCU FY2012 Cases. Opened: 44 Closed: 50

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OFFICE OF ATTORNEY GENERAL

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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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