Spokane nurse practitioner, business hit with 68-count criminal complaint alleging widespread Medicaid fraud

A 59-year-old registered nurse practitioner from Spokane, accused of defrauding Medicaid of $5 million, faces 68 criminal charges.

Paul B. Means, registered owner of the firm Abilia Healthcare based on Spokane’s South Hill, was formally charged Thursday with felonies including leading organized crime, theft, use of proceeds of criminal profiteering, money laundering, false Medicaid statements and witness tampering. Means is scheduled to appear before a judge in Spokane on Jan. 4, according to court records, following a three-year investigation by the Washington Attorney General Office’s Medicaid Fraud Control Division.

A message left at a phone number Means used to register Abilia Healthcare with the state was not immediately returned Friday. Phone and email messages left with an attorney representing Means in his civil case on Friday also were not returned.

According to a 247-page complaint filed by Scott Tollackson, a supervising special agent with the AG’s fraud division, the investigation into Means and Abilia began with an audit of Medicaid billing in 2019. Investigators discovered that certain codes the firm used in billing the government health program designed to help the poor far exceeded other institutions in the state, including major hospitals and service providers, beginning in 2017, and that there was no documentation to support the billing.

Review of records obtained during a November 2020 search of Means’ homes on the South Hill and subsequent interviews with patients and staff at American Behavioral Health Systems, where Means and his employees provided services, showed that Means would bill Medicaid for face-to-face services as described in Medicaid codes lasting up to an hour or more. Those services were instead provided via videoconferencing and often lasted less than 15 minutes.

Means met with investigators in November 2020, according to the complaint, and described his billing processes. During that interview, Means said “he did not know much about the specific codes that he billed,” according to Tollackson’s report. He also told investigators he’d hired contract workers, whom he referred to as “back office” staff, in the Philippines for data entry.

Investigators allege nurses working for Means would prepare notes based on the services they provided a patient, and that Means would then access those notes and alter them to increase the billing amount from Medicaid using an automated system. Authorities recovered videos believed to be used to train those working in the Philippines how to use the automated text system to prepare falsified patient reports for billing.

Nurses working for Means later told investigators when reviewing their notes they did not enter text that appeared to be created by the automated system and increased the billing amounts for Medicaid. Investigators concluded that the nurses were “generally not able to see their prior encounter notes so they were not aware that Means was altering the notes.”

A day after authorities served a search warrant at Means’ residences, he emailed a contact in the Philippines informing them that “we have been shut down” and requesting that they not speak to “anyone trying to contact you.” Those emails, and internal messages, were later obtained by investigators.

Investigators allege the proceeds of the fraud were used to purchase several vehicles and two homes, one on the South Hill and one in Cheney. A separate civil case filed in November 2020 in Spokane County Superior Court has been placed on hold while the criminal charges are resolved.

Abilia ceased operations and Medicaid billing following the November 2020 search of Means’ home, according to court records. Means remains a licensed nurse practitioner in the state, according to the Washington Department of Health, and there are no disciplinary actions on his record.

The charges Means faces are all felonies, the most serious of which – leading organized crime – carries a potential life prison sentence and a fine of up to $50,000. The Attorney General’s Office, in a news release Friday, indicated it would seek a sentence above what is known as the standard range, a calculation of time of imprisonment based on a person’s criminal history, citing “the high degree of sophistication, lengthy period of time, and scale of the monetary loss.”