What motivates a smart person to make dumb unethical choices – choices that have long lasting consequences? That question will be best answered by Dr. Wayne Wilson, 54, Hickory, NC, who entered a guilty plea to health care fraud charges for submitting to Medicare and Medicaid over $467,376 in fraudulent reimbursement claims.
What was he thinking?
According to filed court documents, Wilson is a licensed family practitioner and owner and operator of Wayne Wilson, MD Family Practice (the Practice) located in Hickory. Wilson admitted that from 2007 to 2014, he engaged in a scheme to defraud Medicare and Medicaid by submitting fraudulent reimbursement claims totaling more than $467,376 for services that were never provided to beneficiaries. The fraudulent claims resulted in payments of at least $210,120 to Wilson and the Practice.
How did he do this?
According to plea documents, Wilson “added and padded” his Medicaid and Medicare reimbursements with these false claims because he believed that Medicaid did not pay him enough for his services.
That’s a brilliant plan!
Wow…so I’m not being paid enough so I should just defraud the government to even the playing field. Damn! Sorry for the language, but that’s just stinkin thinkin! That’s like saying the government isn’t using my taxes wisely, so I’ll just pay what I want and deal with the consequences later. Mind boggeling!
Court records show that in some instances Wilson perpetrated the fraud by adding non-existent services, such as nerve conduction studies, strep tests, and pulmonary stress tests among others, to actual patient office visits. In other instances, Wilson fabricated entire office visits and submitted fraudulent claims for dates that patients were not even seen at the office.
According to admissions reflected in the plea documents, beginning in 2005, Wilson contracted with an individual identified as “D.D.” to perform nerve conduction studies, and sought reimbursement for those services through the Practice. In February 2012, D.D. terminated his relationship with Wilson and the Practice. Court records show that Wilson continued to submit fraudulent reimbursement claims to Medicare and Medicaid, falsely stating that he had performed nerve conduction studies for beneficiaries, even though Wilson did not have the equipment or the expertise to provide such studies.
Wilson pleaded guilty to two counts of health care fraud and was released on bond after the hearing. The maximum prison term for each health care fraud count is 10 years and a $250,000 fine. Wilson has also agreed to pay restitution, the final amount of which will be determined by the Court at sentencing, which has not been set yet.
Every choice has a consequence! I suspect that former Dr. Wilson now might have a different opinion about his past actions. If not now he most certainly will during and after his stint in federal prison.
YOUR COMMENTS ARE WELCOME!
My son sees the PA in that office as do I. My son had an appt today, they just called and said they can’t see him bc he has NC health choice. I said he needs his pills, they said take him to ER or urgent care sorry. that bs
Dr Wayne Wilson was a wonderful doctor I had been going to him for year’s I give him a 5 star