The owner of a Spokane-based health clinic is facing charges of theft and money laundering after investigators allege fraudulent Medicaid billing totaling more than $5 million since 2017.
Paul Means, and his firm Abilia Healthcare, were targeted following an audit of its billing that revealed irregularities, according to court records. Investigators believe the proceeds of the scheme, which involved billing the state for intensive, in-person examinations when they were conducted over the internet or not at all, were used to buy a $300,000 home on Spokane’s South Hill and several vehicles.
Means, who has been practicing in the state since 2009 and has no evidence of discipline from the Washington Department of Health, declined comment on the allegations when reached by phone Wednesday. He referred comment to his attorney, but did not name one before ending the phone call. No attorney was listed in court records as of Wednesday.
Investigators from the Washington Attorney General Office’s Medicaid Fraud Control Division have been tracking Means since at least March, according to court records. They were tipped off by an abnormally large amount of billing codes indicating in-person consultations lasting half an hour or more, many of them at an in-person substance abuse treatment center in Spokane Valley.
Claims for payment are submitted under a specific billing code, and the health care authority is responsible for checking to see if the documentation matches the request for payment. An independent audit of Abilia’s records indicated that 97% of more than 6,000 claims for payment submitted by the company were not justified, according to court records, and there was evidence that the company was simply copying and pasting written justifications for payment in multiple case files.
Patients interviewed indicated that their visits were frequently conducted on tablet computers, and often lasted 10 minutes or less. Surveillance showed that during some of these purported consultations, Means was driving across the state or running errands, officials say.
At least three of the Abilia employees who completed patient visits that were later billed as in-person visits live outside the Spokane area. One lives in South Carolina, according to court records.
Means established the firm in 2013, but the irregular billing did not become apparent until mid-2017, according to the investigative report prepared by Scott Tolackson, a senior investigator with the fraud control division. That report was unsealed in court records last week, the same day that a summons was issued to Means and four of his employees.
Means’ purchases this year included a 2020 Lexus luxury SUV and a 2019 Airstream travel trailer. The latter was purchased, Means wrote in a letter seeking an exemption to allow the sale during COVID-19 restrictions, to enable him to travel weekly across the state to visit patients in Western Washington.
A tracker placed on the trailer indicated it traveled just once from Means’ home on South Helena Street, and then was parked overnight at a campground near Bellingham in August, not near a treatment facility.
Abilia also applied for, and received, $110,000 in coronavirus aid assistance from the federal government, according to court records. The University of Washington also paid the company a little more than $176,000 “for participation in a study of medication-first treatment for opioid disorders,” according to court records.
Investigators serving the search warrant seized several vehicles, two South Hill homes and a property in Cheney, all believed to have been purchased with fraudulent funds.
The warrant indicates investigators will pursue charges of first-degree theft, a felony punishable by up to 10 years in prison; making a false Medicaid statement, a felony punishable by up to five years in prison; and money laundering, another felony punishable by up to five years in prison.
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